by Rebecca St. Andrie

"How would you treat this patient?" "Does anyone know how to submit a claim for this?" "What's the deadline for filing appeals?"

E-mails, phone calls and conversations between O&P practitioners center on questions like these. 

AOPA’s National Assembly centers on the answers. Held Sept. 17-20 at The Venetian Hotel, Resort and Casino in Las Vegas, it will feature four days of business and clinical programming offering over 34 continuing education credits to orthotists, prosthetists, pedorthists and other credential holders. 

If you haven’t already registered, the vignettes below should sway you. We interviewed just a handful of the expert presenters who will be at the Assembly. Read why they think you should come to the sessions, and how they’ll answer your questions. 

You’ll find that if you want to get your questions answered, AOPA’s National Assembly is the place to be.

Why can research be so challenging to apply?
“Most people, when they think of evidence-based practice, think of huge clinical trials,” says speaker Edward Neumann, CP, PE. 

“Clinical trials seek to see if a belief really stands up under scientific scrutiny. But you still have to decide what to do for a patient.” 

Neumann’s session, “Evidence-Based Practice in O&P—Clinical Questions and Reasoning,”seeks to help practitioners balance what they read in a journal article with the needs of a particular patient. “Evidence-based practice is not the way of doing a study, it’s a way of reasoning in the clinic,” he says. “Inductive reasoning happens in the clinic, and is based on what works and what doesn’t,” whereas most research is based on deductive reasoning.

Neumann proposes teaching abductive reasoning—a way of reasoning that seeks to balance the two. Abductive reasoning means practitioners can read a particular research article and know how its conclusions might apply to their patients. “I want them to have the confidence that they are reaching a logical conclusion [when deciding what care to give a patient],” he says. “This session will help them word a letter of necessity, or write patient notes.” 

How do I code this?
“Hello, this is Sean Peterson. How may we help you today? …Yes, you do actually need to have that. That’s one of the requirements before you can bill Medicare…” 

AOPA’s coding and billing experts help members navigate tough reimbursement scenarios every day. Their expertise will be on display in this session. Designed to be interactive, it will give attendees the opportunity to ask their toughest policy or billing questions. 

Peterson, AOPA’s reimbursement services coordinator, notes the popularity of the question-and-answer sessions at AOPA’s Coding and Billing seminars as proof of how popular the new “Ask the Expert” session will be. 

“People really like being able to hear the questions other people ask,” he says. At the Coding and Billing seminars, in fact, the question-and-answer sessions have to be curtailed because “people just keep coming.”

It’s the interaction, and the ability to hear what others are struggling with, that is attractive. Those who participate in these sessions hear what’s happening in different parts of the country and get an idea of upcoming trends. Or they’re able to pose “I tried that, but…” questions that give them the needed follow-up to apply principles to their own practice. 

From experience, Peterson also knows how valuable some of his information is to practitioners.

“I hear a lot of situations where, if practitioners get denied, they should appeal,” he says. “But most don’t know what their rights are.” As an example, he cites the often-confusing area of SNF billing. (See “Check, Please!” April 2007 O&P Almanac.) “We’re going to give them tricks and suggestions for billing.” 

Does this shoe fit?
“Most clinicians go the easy route,” says speaker Jeff Reser, CO, C.Ped, BOCO. “They give a [diabetic] patient a shoe that’s the right size, three pairs of inserts, and send them off.

“But we find that about 60 percent of those patients need additional modifications in order to help them walk better, relieve pressure on their feet, and heal wounds. So this session is for orthotists, prosthetists, and pedorthists, to give them some simple things to do [to improve patient outcomes].” 

Reser designed his session, ”Improving Diabetic Shoe Outcomes,” to fill in the education gap he saw in O&P. It’s not inattention that causes practitioners to go for the simple solution, he says—just inexperience. 

“In the mid-‘70s, the shoe business became dominated by big chains. The people who fit shoes sort of went the way of the [full-service] gas station,” he says.

“Now a whole generation of shoe fitters is gone, and diabetes has skyrocketed in the past generation. There are no courses in shoe fitting.” 

Reser designed his session to give attendees a step-by-step evaluation of the diabetic foot. 

“I’m going to break it down into assessment; choosing the right shoe; modifications; and follow-up,” he says. “Most people have a short-term approach. I’m going to try to get them past the first year and into building a long-term relationship.” 

Where did that L code go?
If you think the L code list is shrinking, you’re right. This year’s changes (see “Navigate the NEW HCPCS Codes,” January 2007 O&P Almanac), for instance, saw 45 specific upper-limb codes reduced to nine. 

Of course, Medicare wants a simple coding system. But O&P coding was designed to be an add-on system, in order to describe all of a device’s nuances and features.

Now those details are being lost, says speaker Joe McTernan, AOPA’s director of reimbursement services. “For instance, now we’re seeing a lot of codes that have ‘with or without’ in them, such as a spinal brace ‘with or without soft interface.’ The problem is, both are reimbursed at one rate—usually the lower of the previous two rates—and it costs more to line a spinal brace.” 

The latest changes are in upper-limb terminal devices. Formerly specific codes for terminal devices are now described under L6704, terminal device for sport/recreation/work attachment, any material, any sizes, with no distinction between pediatric and adult devices. 

AOPA is working to protect the necessary distinctions in L codes. The session, “Is Your L Code Disappearing? The Effect of Code Globalization” will examine its efforts. It will also show manufacturers what they can do to clearly delineate the need for new codes in their L code applications. 

“The deadline for new L code applications is January 3,” says McTernan. “This session will show manufacturers how to properly write applications with adequate lead time.” 

Why does my patient keep having heel pain?
“Heel pain” is a vague term. Often a patient will come in with a prescription that reads “Diagnosis: heel pain. Prescription: Orthotics.” With such vague direction, how do practitioners know what’s best for the patient?

According to speaker Erick Janisse, CO, C.Ped, BOCO, most pedorthists and orthotists faced with a prescription for heel pain immediately think of plantar fasciitis. But there are several conditions that fall under that umbrella. “I want this session [“Unraveling the Mystery of Heel Pain”] to help them be aware of other conditions and treat them accordingly,” says Janisse. 

For instance, the prescription above might stem from tarsal tunnel syndrome, plantar pad inflammation, or Achilles tendonitis. Each of these [should] be handled differently, says Janisse. 

He’s designed his session to cover all of these conditions. For instance, Janisse says, “for tarsal tunnel, I’m going to present a little different approach. 

“Often the condition really baffles people. It’s hard to correct the underlying deformity without putting pressure on the nerve.” 

Where’s a therapist who knows how to handle upper-limb amputees?
Upper-limb amputees are a highly specialized population. While most prosthetists have a fair number of upper-limb patients, a physical therapist could come out of school and go several years without seeing a case. Combine that with the rapid advancements in prosthetics, and you have a huge education gap. Speaker Bambi Lombardi, OTR/L, wants her session, “Improving Upper Extremity Prosthetic Outcomes Through Teamwork” to help prosthetists close that gap for themselves and for the therapists they work with. 

Lombardi cites the above scenario as one that creates a lot of potential problems. “Unless a prosthetist has a therapist that he or she regularly works with, it’s hard to find a therapist who knows how to work with a patient needing one of these limbs,” she says. “One [area] that immediately comes to mind is early intervention. 

“Often a prosthetist will wait until the arm is completed before getting in touch with the therapist. But there are so many pre-prosthetic techniques and interventions, like strengthening the patient’s muscles so that he or she can hold up a 3- or 4-pound arm. It makes for easier acceptance and better control.” 

Lombardi’s session will discuss how to work with and educate therapists so that the patient has the best possible outcome. It will also cover the resources, such as video training modules and lists of trained therapists. 

“Upper-limb prosthetics [are] getting advanced enough that it’s even more important to be able to use them,” says Lombardi. “It used to be that they were regarded as a tool to give people a little more functionality and something to fill out their sleeve. But now they’re more advanced—people are starting to say it feels like an arm.” 

What’s your question?
If you haven’t seen the question (or answer) you need yet, turn to the National Assembly’s preliminary program, available online in PDF format at www.aopanet.org/_assets/documents/pdf/2007PreliminaryProgramWeb.pdf. You’ll find many more sessions like these, designed with your interests in mind. You’ll also find a raffle for a Harley-Davidson motorcycle, panel discussions on hot topics like licensure, plenty of time for networking and a special exhibit on the history of O&P. Registration is available online at www.AOPAnet.org/op_events/national_assembly. 

Rebecca St. Andrie is managing editor of the O&P Almanac.