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Linda Collins Blogger

Documenting Instability for Knee Braces

Posted by Linda Collins | August 22, 2017

Per the Local Coverage Determination (L33318) and Policy Article (A52465), a knee orthoses billed with HCPCS   L1851, L1852, L1832, L1833, L1843, L1845 and L1850, may be covered when the patient is ambulatory and has knee instability. The knee instability must be documented in the physician's medical records and an objective description of the examination must be included.

It is not sufficient to simply state "unstable knee" or "knee instability." The instability must be objectively determined by measurement of varus/valgus, range of motion, anterior/posterior Drawer test or similar exam. When this information is not contained in the medical record, the claim may be subject to denial.

What does this mean for you?

Check your medical records, inform you referral sources and document instability to support the medical necessity of your knee orthoses claims.

Review the Knee Orthoses LCD and Policy Article here (pdf download). Ösur has created a "Knee Bracing Checklist" reimbursement resource for you which will provide more information. You can access this resource here.

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