Suppliers often are billing miscellaneous code L5999 (LOWER EXTREMITY PROSTHESIS, NOT OTHERWISE CLASSIFIED) for various elements of microprocessor-controlled knee systems that are considered included in the established code. This use of miscellaneous codes is not correct. For example (not all-inclusive), functions performed by the on-board microprocessors and/or sensors such as "real-time gait assessment," "electronically controlled static stance regulator, adjustable", or the programming necessary for set-up and use of the knee, must not be billed using L5999. There is no separate billing and reimbursement for any other features or functions billed with L5999 since the allowance for all functions and features is included in the payment for codes listed below.
Other than the exception discussed above, knee mechanisms are selected by the same criteria as for transfemoral (above-knee) amputees. The single-axis (constant-friction) knee remains the most widely utilized due to its light weight, low cost, and excellent durability. Friction resistance is often eliminated to ensure that the knee reaches full extension as quickly as possible. A strong knee extension bias enhances this goal and offers the patient the most stable biomechanics possible with this mechanism. Although the single-axis type was proposed as the knee of choice for the Canadian hip disarticulation design, more sophisticated mechanisms have proved their value and are gradually becoming more common.
Heavy Duty Endoskeletal Prosthetic Knee .
In an effort to overcome this limitation, the hip flexion bias system was developed for the young, active amputee who wished to walk rapidly. At toe-off, kinetic energy from the coil spring is released, and the prosthetic thigh is thrust forward. Not only does this provide the amputee with a more normal-appearing gait, it also improves ground clearance. As a result, the prosthesis can be lengthened to a nearly level configuration in most cases (Fig 21B-5.). However, two potential problems have been noted with this approach. One is the development of annoying squeaks in the spring mechanisms after a few months of use, which sometimes tend to recur inexorably. A more significant concern is that as the spring compresses between heel strike and midstance, it creates a strong knee flexion moment. Unless this is resisted by a stance control knee with a friction brake or a polycentric knee with inherent stability, the patient may fall. Since the friction-brake mechanisms lose their effectiveness as the surface wears, the polycentric knee is the preferred component with this hip mechanism.
addition to lower extremity prosthesis, endoskeletal knee-shin ..
Advanced systems are available for amputees who wish to run. Swing phase control systems can include either pneumatic or hydraulic control systems to enable the wearer to run or vary walking speeds. Newer "high tech" knees include those with microprocessors which are adjustable throughout the life of the prosthesis, often using a laptop computer to alter them. Other lightweight knee frames include those made of graphite, which house small adjustable knee control units.
endoskeletal system, above knee or hip disarticulation:
The knee allows the prosthesis to bend while you are standing on the foot and when taking a step forward. Prosthetic knees are designed to avoid buckling when standing and to allow the artificial leg to be advanced normally at will. Special designs can allow you to walk on uneven ground or to run and change speed. Typically younger and more active amputees wear these knees. Your prosthetist will discuss your activity level with you to allow special options to be included in the design of your prosthesis.
Above Knee Prosthetics - WCR BOULDER CLINIC
Recent claim reviews note that suppliers are billing miscellaneous code L5999 (lower extremity prosthesis, not otherwise classified) for various elements of microprocessor-controlled knee systems such as the Otto Bock C-Leg®, C-Leg Compact™, or Genium™. This use of miscellaneous codes is not correct. For example, functions performed by the on-board microprocessors and/or sensors (e.g., "real-time gait assessment," "electronically controlled static stance regulator, adjustable"), or programming necessary for use, must not be billed using L5999. Use of additional codes is limited to those specified below. There is no separate billing and reimbursement for any other features or functions since the allowance for all functions and features is included in the payment for codes listed below.
Information about above knee prosthetics and the Hi-Fi ..
Many authors have noted that the rejection rates for lower-limb prostheses are the highest at these proximal levels. The energy requirements to use such prostheses has been reported to be as much as 200% of normal ambulation. At the same time, the lack of muscle power at the hip, knee, and ankle/foot results in a fixed, slow cadence. As a practical matter, only those who develop sufficient balance to ambulate with a single cane (or without any external aids at all) are likely to wear such a prosthesis long-term. Those who remain dependent on dual canes or crutches for balance eventually realize that mobility with crutches and the remaining leg, without a prosthesis, is much faster and requires no more energy expenditure than using a prosthesis does.