Documenting Functional Levels

A lower limb prosthesis may be covered when there is documentation to support the patient will reach or maintain a specific functional level. The documentation must be corroborated in the physician's medical records. Simply stating the K level and definition is not sufficient. Your documentation and the physician's documentation must list the activities and details that allow a review to determine functional level.

A patient's functional level is based upon the evaluation of the prosthetist and treating physician. The assessment may include, but not be limited to,

• a review of the patient's past medical history
• prior prosthetic use
• assistive devices used and when
• the patient's current medical condition
• co-morbidities
• the condition of the residual limb
• symptoms limiting ambulation
• description of activities of daily living and how impacted by limb loss
• gait
• balance/coordination
• strength
• and the patient's desire to ambulate

A Physician Worksheet for Prosthetic Documentation, which a tool to use when communicating documentation needs to the treating physician, may be downloaded under the Reimbursement Resource section of this page.