We have nothing to disclose Orthotics, Braces and Splints: Sports - - PowerPoint PPT Presentation

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Tim Baldwin, MA, ATC, CFo Amber Pryor, MS, ATC, CFo

Orthotics, Braces and Splints: Sports Medicine DME Pearls

UCSF 13th Annual Primary Care Sports Medicine Conference

Orthotics, Braces and Splints: Sports Medicine DME Pearls 3

We have nothing to disclose

Orthotics, Braces and Splints: Sports Medicine DME Pearls 4

Overview

• Knee Braces
• Acute vs Chronic
• Ankle Bracing
• Acute vs Functional
• Spine
• Cervical vs TLSO vs LSO
• Hand, Finger, and Elbow
• OA vs Immobilization vs

Chronic

• Nighttime Splinting
• Wrist vs Elbow vs Feet
• Insurance Pearls

Orthotics, Braces and Splints: Sports Medicine DME Pearls 5

Knee Bracing

Acute vs Chronic

• Acute
• T-Scope
• Gold Standard
• Knee immobilizer
• Short term
• Long hinged knee brace
• Short hinged knee brace
• Patella stabilizer
• Most commonly lateral

control

• Chronic/Functional
• ACL
• Unloader
• Single vs Double Upright
• Patella stabilizer
• Hinged knee brace
• Sleeves
• Not covered
• Patellar tendonitis
• Most not covered

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Orthotics, Braces and Splints: Sports Medicine DME Pearls 6

Ankle Bracing

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Ankle Bracing

Acute vs Functional

• Acute
• CAM/FAW
• Short vs Tall
• Wedging
• Balance other side
• Stirrup
• Short vs Long Leg
• AFO
• Custom vs OTS
• Foot
• PO shoe/Heel

cup/Offloader shoe

• Chronic/Functional
• Figure 8
• Rigid and Semi-rigid
• PTTD Aircast
• Hinged ankle brace
• Functional Foot Orthotics
• Custom vs OTS

Orthotics, Braces and Splints: Sports Medicine DME Pearls 8

Spinal Bracing

Orthotics, Braces and Splints: Sports Medicine DME Pearls 9

Spinal Bracing

Cervical/TLSO/LSO

• Cervical
• Soft Collar
• Miami J
• Aspen
• Headmaster/Springwire
• TLSO
• Soft custom TLSO
• Backpack style
• LSO
• Rigid panel
• Corset
• Binder
• Postural
• Figure 8/Clavicle
• Mother to Be
• Specifically for pregnancy

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Orthotics, Braces and Splints: Sports Medicine DME Pearls 10

Hand, Finger, Elbow

Acute vs Chronic

Orthotics, Braces and Splints: Sports Medicine DME Pearls 11

Hand, Finger, and Elbow

Acute vs Chronic

• Acute
• Jammed finger,

dislocation, fracture, laxity

• Most treated with stack

splint or oval splint

• Stack for multiple joints
• Mallet finger/avulsion

Fx/extensor injury

• Oval-8 for laxity/single joint
• PIP joint
• Chronic
• CMC Arthritis
• Brace doesn’t involve wrist
• Moldable stays or heat

molded

• Elbow
• Olecranon Bursitis
• Elbow pad 24/7
• Spider pad suggested

Orthotics, Braces and Splints: Sports Medicine DME Pearls 12

Nighttime Bracing

Orthotics, Braces and Splints: Sports Medicine DME Pearls 13

Nighttime Bracing

Wrist/Elbow/Leg

• Wrist
• Most common carpal

tunnel or DeQuervains

• Wrist splint vs Thumb

spica

• Elbow
• Cubital tunnel splint
• Keep in 122 degree

extension

• Leg/Feet
• Plantar Fasciitis
• Progressive stretching

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Insurance Pearls

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What form must a patient sign if their brace is considered not medically necessary or a non-covered benefit by Medicare?

• 1. ABN
• 2. NPI
• 3. COF
• 4. CPO
• 5. TMI

BT1

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Insurance Pearls

Tips and Tricks

• Pain is not a diagnosis, it’s

a symptom

• MD notes overrule O&P

notes

• If you work with an O&P
• ffice, have them provide

in-service

• Must state medical

necessity of brace

• Limit use in note to 1 year
• Knee braces most

scrutinized

• State instability, even

pseudo laxity

• Download CMS lower

extremity guide

• Must be rigid or have

hinges to be billable

• Cold therapy not covered
• Must have seen in last

year for Rx

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Slide 14 BT1 ABN - Advanced Beneficiary Notice (3 Options)

Baldwin, Timothy, 11/28/2018