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Whenever selecting a diagnosis code for any bracing, all insurances are now requiring the most specific code to be chosen. A code describing the specific limb (e.g. leg, knee, wrist, elbow, shoulder, upper limb, lower limb, wrist, etc) and describing the left/right side (LT/RT) should be used in most cases. For example when ordering wrist braces for a patient with carpal tunnel:Non-covered diagnosis: Code does not describe LT/RT limbG56.00 - Carpal tunnel syndrome, unspecified upper limb. Covered Diagnosis: G56.01 - Carpal tunnel syndrome, right upper limb.G56.02 - Carpal tunnel syndrome, left upper limb.(Note: There is not a specific code for bilateral carpal tunnel syndrome, so both codes will need to be included on the prescription.)For example when ordering knee braces for a patient with osteoarthritis of knee:Non-covered diagnosis: Code does not describe LT/RT limbM17.10 – Unilateral primary osteoarthritis of knee, unspecified kneeCovered Diagnosis: M17.11– Unilateral primary osteoarthritis of knee, right kneeM17.12– Unilateral primary osteoarthritis of knee, left kneeM17.0 – Bilateral primary osteoarthritis of knee (can only be used if ordering bilateral braces)In rare cases, a diagnosis may not have a more specific code that may not describe LT/RT. In this case an unspecified code may be used. For example:M65.4-Radial styloid tenosynovitis [de Quervain]Whenever possible, insurances require the most specific code available to be chosen when billing for bracing and included on the prescription. ................
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