Diabetic Foot Ulcers

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Shimi-Shoe Walking Technologies, Inc. Shimon Cohen C. Ped President 5324 Washington Road Delray Beach, FL 33484 Tel: 561-886-8261 E-mail: shimon@shimi-shoe.com www.shimi-shoe.com Covered under US and international Patents Numbers: 6,311,416, 6,692,703 and EP1231851. Other US and International patents Pending DynaWalk™ Recovery with EVERY step

Management of Diabetic Ulcers with Pressure Offloading : 

Management of Diabetic Ulcers with Pressure Offloading Agenda Demographic information/ulcer costs Different Function - Goals in treating diabetic ulcers Orthotic options for healing ulcers

Medicare Code Number A9283 : 

Medicare Code Number A9283 The DynaWalk™ product line was awarded Medicare Code Number A9283, making it the FIRST Medicare Approved Pressure Off-Loading Device The Code reads: Foot Pressure Off-Loading/Supportive Device, Any Type, Each

Orthotic Management of Diabetic Ulcers : 

Orthotic Management of Diabetic Ulcers Post-Op Shoes Protection for post-op foot NOT requiring pressure off-loading. Eliminates need to build walking heel into cast, saving cost and minimizing limb length issues. Applications For dressing protection on post-op foot NOT requiring pressure off-loading

L3260 “A post-op shoe” : 

L3260 “A post-op shoe” “Cast” shoes Description A cast shoe with a wedge sole. Can not be adjusted to location of the ulcer for pressure off-loading. Creates sever limb length discrepency. Can only walk with walker or crutches. Billed under L3260.

Comparisons to L3260 : 

Comparisons to L3260 Diabetes demographic information: 18 million diabetics (2001) 13 million diagnosed About 10% of Diabetics will develop a Diabetic Foot Ulcer 82,000 amputations performed in 2001 85% of amputations preceded by Diabetic Foot ulcers 45%– 85% of amputations performed are avoidable Costs: Each ulcer costs $6,664.00 Each amputation costs $26,126.00

Goals in Treatment of Diabetic Ulcers : 

Goals in Treatment of Diabetic Ulcers Goals Controlled and Precise Pressure Off-Loading for the treatment of diabetic foot ulcers Heal ulcers to prevent amputations Minimize costs of long term ulcer care to healthcare system

Orthotic Management of Diabetic Ulcers : 

Orthotic Management of Diabetic Ulcers Orthotic options for healing ulcers Total Contact Cast (TCC) CROW Walker Diabetic cam walkers DynaWalk™

Orthotic Management of Diabetic Ulcers : 

Orthotic Management of Diabetic Ulcers Total Contact Cast (TCC) Advantages Most appropriate for non-compliant patients Immobilizes foot/ankle complex Reduce further trauma Maintain ambulation Disadvantages Weight Added limb length Potential joint stiffness Possible skin abrasions

Orthotic Management of Diabetic Ulcers : 

Orthotic Management of Diabetic Ulcers Total Contact Cast (TCC) Costs Applied every 7 to 10 days Billed under CPT 29405 A4590 Reimbursement: $235.00 X ± 4 $940.00

Orthotic Management of Diabetic Ulcers : 

Orthotic Management of Diabetic Ulcers CROW Walkers Advantages: Allows ambulation Can be partial weight-bearing Allows daily wound management Disadvantages: Weight Creates LLD Gait imbalance Heat and moisture retention Requires custom built-in foot orthotic

Orthotic Management of Diabetic Ulcers : 

Orthotic Management of Diabetic Ulcers CROW Walkers Costs One-time billing Billed under L-1960 L-2340 L-3410 L-2820 Reimburses: $968.11

Orthotic Management of Diabetic Ulcers : 

Orthotic Management of Diabetic Ulcers Diabetic Cam Walkers Advantages: Allow ambulation Low tech Allows dressing changes Disadvantages: Require compliance Create limb length discrepancy (LLD) Create gait deficit Variable compressive forces No custom pressure Off-Loading adjustment Shearing forces

Orthotic Management of Diabetic Ulcers : 

Orthotic Management of Diabetic Ulcers Diabetic Cam Walkers Costs (pneumatic) One-time billing Billed under L-4360 Reimburses: $208.43

Orthotic Management of Diabetic Ulcers : 

Orthotic Management of Diabetic Ulcers Diabetic Cam Walkers Costs (Non-pneumatic) One-time billing Billed under L-4386 Reimburses: $ 114.03

Management of Diabetic Ulcers : 

Management of Diabetic Ulcers DynaWalk™ Advantages Low tech Movable/Removable Metatarsal bar positioning system to precisely Off-Load Diabetic Foot ulcers No limb length Discrepancy Allows easy dressing changes Allows Daily Monitoring Light weight Allows safe ambulation Allows Free Ankle Movement Accessories for bed use for posterior ulcer or Lower Extremity rotational issues

Management of Diabetic Ulcers : 

Management of Diabetic Ulcers DynaWalk™ Disadvantages Not appropriate for Charcot related ulcers

Orthotic Management of Diabetic Ulcers : 

Orthotic Management of Diabetic Ulcers DynaWalk™ Costs One-time billing $415.00 (Suggested)

Orthotic Management of Diabetic Ulcers : 

Orthotic Management of Diabetic Ulcers CMS cost summary Item Total Cost TCC $940.00 CROW $968.11 CAM Walker (pneumatic) $208.43 CAM (non-pneumatic) $114.03 DynaWalk™ (suggested) $415.00

Orthotic Management of Diabetic Ulcers : 

Orthotic Management of Diabetic Ulcers Although orthotic options exist for off-loading diabetic ulcerations, these orthotics are used for joint support also, and not paid by Medicare for ulcer healing. Successful orthotic intervention can be used to prevent need for prosthetic intervention. Precise Pressure Off-Loading and Proper Wound Management can prevent the need for Amputation.

Medicare Benefit Category : 

Medicare Benefit Category It is most cost effective to use a product that is not custom made, but a semi-custom of the shelf product, designed and developed for the purpose of Diabetic Foot Ulcer Pressure Off-Loading and Ambulating.

Summary : 

Summary On March 2005, the Medicare Coverage Advisory Committee made the determination that off-loading is part of the usual and standard care of chronic wounds. The DynaWalk™ is the FIRST Medicare approved Pressure Off-Loading Device under code A9283. This is the first code issued for the treatment of Diabetic Foot since the Therapeutic Shoe Bill of 1993.

Summary : 

The DynaWalk™ is a Precise Dynamic Pressure Off-Loading Device for the Treatment and Safe Ambulating of Diabetic Foot Ulcers. Special accessories are available to be used during bed/rest time for Pressure Off-Loading of posterior ulcer and Lower Extremity rotational issues All insurers should have a program need for managing foot ulcer, since it is a universal growing domestic problem. Summary

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