Cosi Talks with Special Guests Brian Simmons and Lou Figueroa – Cracking the Insurance Code for RevoFit

Facebook and YouTube and we will be live on Instagram in just a minute so guys

come on board if you are watching the replay thank you for watching the replay comment replay and give me a shout out

give my guest tonight a shout out as well I’ve got Lou and Brian here on loan to me from click medical so thank you to

click medical tonight for sponsoring this show and going live on Instagram all right so

we’re live on all three we’re going to give you guys a minute or two to jump on board and get this show started tonight

so guys thank you for being here tonight appreciate it my pleasure so we we’ll start them

off right we got we got something to Cheers right everybody’s got a mug yeah I got my mug CLI swag all right

cheers guys all right guys I see a couple of you guys popping on board this evening you know the routine don’t be

shy let me know who you are where you’re from and what is in your mug this evening uh speaking of mugs we’re going to be giving away a couple of these Yeti

click medical mugs they’re always a hot item here on the show we got Beth coming in from Georgia Georgia you’re all over

the place Beth last time you were in Florida last week and now you’re in Georgia all right let’s see who else we got coming on board we’re gonna give you

guys another minute or so tonight’s show guys I won’t lie it makes me a little

nervous and that’s why I brought some experts tonight because I’ve never done a show on anything

insurance that is not my wheelhouse but I think that was all the more reason why we needed to do a show because I know

even Brian commented tonight nobody is an expert on insurance and how it works

uh let’s see we got Pastor David it’s a party he’s in the house uh Beth you’re traveling home we’ve got my Tarheel

there Denise from North Carolina all right A lot of people are starting to pop on board all right let’s see who

else we got on Instagram we got VTO jumping on board someone by the name of Grande Rojo and Pam is on board as well

thank you guys for joining me all right we got Dean coming in from Miami and Ed oh there’s my physical

therapist colleague right there from John’s Hopkins Ed living in Baltimore enjoying his keer nice

welcome fancy tonight all right guys we got em hey Emily from Pennsylvania got

back from my first in-person MPT support group congratulations Emily and I’m glad to have you I know you haven’t been able

to make it the past few Wednesdays so I’m glad you are back tonight all right guys we’ve got a nice group on board so

we’re gonna go ahead and get this evening started we got Teresa coming in from Albuquerque as well thank you for

joining in Teresa all right guys so for those of you watching the show for the first time welcome my name is Coy boso

I’m a physical therapist andt specialist here in Tampa Florida been a PT for over 23 years and my passion is working with

the Lim loss community and today I’ve got Lou Figaroa right there and we got

this way Brian Simmons from click medical so they are going to be telling their stories uh and

we’re going to be talking about the insurance code and how that system works in our us-based health care insurance

system and all that kind of fun stuff we got Linda coming in from New York and Bonnie from Tennessee there you go all

right guys so let’s just do a quick start actually Brian I’m GNA stop talking for a minute I want you to

introduce yourself and tell us a little bit about yourself great happy to do it hello everyone uh Brian Simmons I am

with click medical after spending about 30 years in h business Consulting I had

the pleasure and the blessing of meeting the click team about four or five years ago and you know I had been in

healthcare Consulting for a long time and had never heard of O and P and uh when I got to know Jimmy and the team

and I got to know the good work that click medical was doing um and just the passion to bring a solution that we all

love and live with every day we live with adjustability every day our belts our shoes our seat belts our our seats

um when I when I when I saw what the team was doing and the products that were made available to friends like Lou

I I just sort of jumped in and have had the joy of helping grow the company and chase this L code that we’re going to

talk about later and uh I lead business development for click I go out and meet with perhaps any of you were on the

phone that were a prosthetist in the area and uh just work to build your relationships spread the good news of

adjustability and um yeah and it’s and it’s a joy and a pleasure to do it good to be here with you thank you and thank

you for bringing your expertise and we’re gonna be hearing about lose story just a little bit later you’re gonna have to stick around for that one guys

uh before we get started though we’re going to go ahead and announce our first giveaway winner y’all know I love to do my free giveaways on this show so thank

you to click medical they’re going to be sending you a click medical Yeti mug just like the one that Lou has so Lou

you got to do the here I love it by the way it’s awesome

is awesome it’s a very very nice mug guys uh so our first winner for this evening is Randall Archer we had a preg

giveaway so you had to follow uh click medical and Coy talks on Instagram or Facebook and like the post that we had

already posted but we also have two more giveaways coming up for those of you watching live so stick around for that

we got Scott in stormy West Virginia running late drinking Wendy’s orange dreamsicle Frosty in my cup wow that

would sh send into sugar shock we’ve got Kenny in Virginia beach with just his water uh and then Jamie coming in from

cck from click medical so guys if you have been living under a rock and you have never seen my show before and

you’ve never watched any of my shows then let me just introduce click medical so click medical are the makers of the

adjustable socket systems okay their most popular one is called revofit I’ve

got all my toys here so we’re just going to go do a brief overview they have three main products REO fit Revo surface

and Revo lock so the revo fit is providing adjustability into your socket

now this is my demo socket so it’s got a lot of action going on but as you can see you can adjust a socket through a

gap system through a panel system I’ve got all the dials

here and again guys this is the demo socket so there’s a lot of stuff good stuff going on here so there’s a panel

system so you can adjust your socket this way as well the revo

lock is their suspension system and it’s all the way in at the bottom it’s kind of hard to see but right there so we’ve

got their suspension system and then my personal favorite is the revo surface

okay so what I love about the revo surface is that those of you who already have a socket that fits pretty well and

you don’t want to go make a new socket you just need to have that adjust adjustability built in your prostatus

can build it in with a Revo surface kit right so just so you can see the difference this is the revo surface

where you can see the strings on the outside versus the revo fit where it’s built into the

actual socket they both provide the same adjustability guys did I get all this right did great yeah you’re doing great

yeah yeah okay Lou which one do you use currently I use the revo fit and

it’s on my BK so my baloney amputation and I have the grip on it so it’s a little bit easier to turn uh I really

love it I’ve been using it since since 2015 and then now they have do you have the click reel or do you have the boa

dial I have the click reel the new one the new version okay so I love the click reel guys because you can adjust it I

call it forward and backward but it’s really to tighten and then to loosen it you don’t have to release the whole dial

to get it to loosen so you can really do some nice micro adjustments um so this is wonderful it can adjust up to remind

me on this one it’s about 10 ply yeah yeah give or take yep give or take 10 ply so love this I have so many

of you here quick Coy poll how many of you here have a Revo fit or Revo surface

or Revo lock show a hands in the comment section it takes about like a minute for

people to like I have one you got one we got

in there’s like a little time delay I’m just gonna pop over to Instagram make sure everything is cool there all right

we got Jenner on board we’ve got I love reading all the Instagram handles it’s always fun bbac car is

watching while they’re doing that I have this this socket here that’s with me and

we have a couple here so we have a dial here and here and then we have another

one that’s for the V2 is what we call it and that is um a lanyard system so um

you’d pull this dial out and then it’s connected with this kind of locking

liner so that’s you know one of the other options really kind of a cool design you got your Gap there too and

then panels as well so yeah really cool and guys what I love about it is the the

processes can really customize where they put the adjustability on the socket and also where they put the dial so it’s

really nice in that regard all right so Lou your turn tell us yes well I’m Lou

figuroa I am a bilateral npt I have one above my knee and one below my knees so

I have a little bit of best as both worlds and my story is quite unique wear hear often in the NP world uh you know I

had been out with a group of friends and was separated from them along the night and uh we weren’t sure really what

happened if I encountered like a drink that was laced with something or I picked something up on accident but in

any event I ended up um walking out of the nightclub that I was at and

wandering about almost two and a half miles into what would have been the Union Station rail yard and I was

completely unaware of my surroundings at this point they think I was crawling underneath a train when it started to

move and it severed both of my legs and uh really that train didn’t know that uh

that my body had been struck because I was somewhere in the middle of the train so it was the next train that came

through that was like doing routine operations that actually came up on my

body and they’ seen you know that I had been struck by the previous train that had came through so I mean luckily to my

surprise the conductor of the Railway he was trained in the military and he

immediately went into survival mode and he put tourniquets around my legs and

instructed the other conductor to run and grab an ambulance uh I mean people don’t survive

that type of injury um let alone the trauma is one thing right but then you

know you’re talking the loss of both limbs in my hand was severely um crushed

as well so they had to amputate my hand um so that’s really like the core story

of what happened with me you know they they rushed me to the hospital and I went through nine life-saving surgeries

over the next week or so and when I woke up you know my family had asked me how

did this happen and I had a place to stay in the downtown district of Denver

I had a sober driver like I thought I took all the precautions one would take to have a fun night

and this still happened and a lot of my friends were just like man they knew me as a mountain biker a snowboarder

somebody like if it had two two or four wheels on it I was riding it pretty much and a lot of my friends were like wow

what’s going to happen now like how is he gonna move forward and I was in a

wheelchair for about two years and uh during that time I was doing a lot of research about Prosthetics and you know

a lot of the doctors they had high hopes that I would walk again but they’re like man this is going to take him a long

time this is not going to just happen overnight and uh it was about 2 years

later of me being in a wheelchair that I got my first set of Prosthetics and uh

back then it was 2010 somewhere around there and so they were like rigid

sockets they were made out of this hard plastic and there really was no room for adjustability it was like you put it on

you threw on a couple sock Plies and like throughout the day what we’d have to do is you would shed those Plies of

socks off and you would add them accordingly if you gained weight and so

it was about 2015 when I had started using some of the adjustability and wow what a

difference it made in my life just all the trips I was taking back and forth to the prosthetist and you know some of the

skin breakdown that I was having from the Prosthetics not fitting correctly I mean the adjustability was just awesome

to have and so that’s a brief kind of intro to who I am and how I started using the products but you know I’m a

I’m a everyday user now and I just love how we’re able to make those what you called cozy micro adjustments throughout

the day yeah no it’s it’s it’s really it really is that it’s been a game changer for so many of my viewers and my

patients um especially here in hot sticky Florida you know volume limb volume changes so dramatically and to

have to take everything off and put it back on and take it yeah so it’s it’s been a game changer for a lot of folks here um this is the first time I’ve

heard your story Lou that’s that’s amazing amazing yeah kind of crazy I

mean yeah we hear about it all the time people get separated from the group of friends and this is kind of like the severe case of it happening but yeah

what what a journey it’s been and to help a lot of other amputees along the way I hear a lot of people on your show

by the way that are like they just are lost for answers and you’re providing a service to them that is invaluable cozy

I’m just so thank thankful to be a part of this podcast thank you thank you for joining so we got Andrea says forget

what’s in my cup I’m ready for bed long day she’s my occupational therapist so she always chimes in to help me out with

the occupational therapy questions Susan said that she’s heard your story before Lou uh let’s see we

got Rita coming in from Michigan we got Tom out there as well jerianne says I don’t have any but I would love to get

the revo fit I’m a bilateral BK not walking just jet Tampa dolphin Rod Rodney says as a prosthetic technician I

built a socket with the revo today awesome thank you for coming Mar says Maryann she says at first I hated my

Revo click reel but come to find out mine had come loose so Chad fixed it her prosus and now she’s very happy and I

know Maryann you are incredibly active as a bilateral AK so I’m glad that you’re using it uh Sean coming in from

Jacksonville can’t wait for my appointment for Monday and hopefully you can get your adjustable socket yes awesome all right so guys if you’ve been

watching the show you know that when it comes to the questions on insurance I don’t really have answers a lot of the

times this is not something that I consider to be my forte at all in my own private practice it’s a cash-based

practice so I don’t work with insurance I used to Once Upon a Time and I will admit I always struggled with it um it

is a very complicated system there’s a lot of rules and I feel like it’s like Facebook and Instagram they change the

rules every five minutes it feels like some and just when you’re getting the hang of it right so as a patient and

knowing you know how this system works you know whatever information you can arm yourself with is just going to help

you especially for those of you who have had prosthetic componentry denied by your insurance companies I’m sure if I

took a poll let’s do another Coy poll how many of you have ever had a prosthetic component denied or Services

any kind of services denied by your insurance company um janne says Lou a lot of

people have train accidents and you’re amazing yes agreed oh thank you thank you Jill so guys let’s we’re going to

kind of give you the basic breakdown and I kind of organized it into like a funnel type organization because y’all

know I like to keep things organized all right so let’s talk a little bit about the head hono the head hono in the

United States Health Care system is called the centers for Medicare and Medicaid services it’s also known as CMS

the government loves their initials that make no sense okay and guys don’t worry about

taking notes I will be providing a cheat sheet for you to download and you’re just going to have to watch my social

media because I have all the information I’m talking about tonight it’s going to be available to you next Monday so all

you got to do is listen tonight right so we’ve got the centers for Medicare and Medicaid services and that one’s an easy

one right they are in charge of Medicare and Medicaid they’re also in charge of Chip which is the Pediatric version of

Medicaid right and they they have their hands in a lot of things right they help control with HIPPA they help regulate uh

standards for nursing homes and among the many many things that they do they are the ones who created this lovely

Insurance coding system that we have okay so that’s the CMS centrals center

for Medicare and Medicaid services so CMS created it’s called the healthc care

common procedural coding system and yes that has more initials hcpcs right we call it I I call it hick

piss I can easiest way I can pronounce it okay so CMS created hi and that is

the coding system that we use okay and it’s organized into two different levels

it used to be three but now we just use the two main levels right level one okay

it’s called the CPT codes common procedural terminology right and this is

where all your medical Surgical and diagnostic services are coded under the CPT codes um this is what actually

physical therapists this is what we use when we do our coding and it’s all numeral codes so for example if I did a

gate training so if I was gate training my patient for 15 minutes then I would use the code I even wrote it down

97116 right that’s the code that I would write down on my patients Bill and send it off to the insurance and the

insurance company would say okay she did gate training according to this code we reimburse for this amount and that’s how

it works right level two codes okay are for basically everything

else so all the items supplies that you may use nonphysician Services everything

is covered in level two and in level two you have codes a through V and this is

where the L code Falls in how am I doing guys so far so good fantastic all right

so guys we’re gonna do repetition is the mother of memory so I’m just gonna kind of go over that again at the tip top we

have Central for centers for Medicare and Medicaid services CMS they created hick pit the insurance

coding system we have level one and level two right for the coding systems

level two is where the prosthetic action is this is where your prosthetists will have their noses buried in this part of

the manual looking for everything okay so I mentioned level two they have codes

a through V you’re right in the middle with L codes so if you’ve ever heard

your prosthetist use the term L code this is what they’re referring to Okay

so this is where you’re going to find all the prosthetic devices right so that’s basically it did I miss

anything Brian well I would I would add one or two things um you didn’t miss anything but the one thing I would add

would be that it all starts with what CMS does for Medicare for the Medicare population and then and then all others

let’s say follow but it doesn’t mean they follow exactly but they they sort of wait for Medicare to make a decision

about something before they even put their toe in the put their toe in the water and decide if they’re going to pay

attention at all to that particular code y so that’s that’s the that’s the that’s probably the most important thing that I

kind of wanted to throw in there and that’s that’s the that’s the part I remember hearing about when I was in

insurance-based clinics was Medicare made a decision that means the other private insurances are going to probably be keeping an eye and having some sort

of reaction to it the VA follows very closely because kind of by law they have

to I think by law they have to pretty much follow what Medicare does the reimbursement rates could be different but the coverage is going to be very

similar Medicare Advantage of course has their own sort of um limitations and

restrictions based on the commercial the commercial payer that has the Medicare Advantage plan and then

commercial insurers through employers and whatnot they’re going to they’re going to do what they do but but the point is it all begins with what CMS

decides to do and then um so when a when a new code gets created or when CMS

makes a decision everyone pays attention because it means there’s a cascading effect to what’s going to happen next

and a new code means good things are going to happen yes and guys we’re going to tell you a little bit more about why that should matter to you in just a

second but we’re going to do our second giveaway this evening my girl Jamie is gonna post a link and it’s gonna take

you to the click medal website specifically to lose story so you’re gonna see his handsome hug on that

website and the giveaway question is what are the two

systems that Lou uses from click medical and you got to put that into the comments section there is a yeti mug at

stake for this guys yeah good luck good luck so Jamie just posted that link for you all you gotta do is right click do

not click out of the show um Brandon’s like Brian is the man you got a fan there Brandon what’s up buddy how are

you all right so guys once again for that giveaway we got a lot of folks joining in on Instagram hello

Brad all right so for the giveaway go to that link that Jamie just posted

and let me know what are the two click medical systems that Lou

uses yeah good luck I could tell you as an NT like one of the codes I always heard and I was just like ah frustrated

me was L 5999 it’s like the L 599 code was like

yes that’s where everything that’s where prosthetic devices go to die that’s that’s the L 599 so guys if you’ve heard

of The L 5999 code it’s basically the junk code the dump code I don’t know what else to classify it as code um so

whenever your prosthetist has a particular component that does not have its own specific L code they assign it

the L5 9999999 code um and a lot of times that means that insurance may

go and deny it okay everybody everybody hold that thought because Coy I want to

talk about the importance of the utilization of that code for new technology we’re going to bring that into the conversation later it’s a

really important point that it has a it has a reputation of being what you described and that causes people to not

do what we as innovators need them to do to get new technology recognized I can’t wait to talk about that oh good because

I don’t know about that so this is something I need to learn too so Don says great talk for us us people unfortunately I’m in Canada but

understand our system here in a good show signing off thank you Don uh so guys the question ultimately is well why

do we when we’re patients why do we need to know about the coding system and the best analogy I could think of is when

you go to a restaurant right you go to a restaurant you order a very nice meal and the waiter brings you the bill what

should you be doing looking at the bill right you should just do a quick check to make

sure that you know the three drinks that you ordered are in fact the three drinks that you ordered right and check through

everything and sometimes in the in the restaurants they might have their own coding system for what they’re billing

you for but you can more or less figure out this matches up to what I ordered and if it’s something that you did not

order then you send it back and have them corrected and not be charged for it same thing with our prosthetic and our

Medical Care Services we should all theoretically when our insurance bills

come in we should be looking at these bills okay and we may not be coding

experts ourselves but at the very least we should be able to more or less identify the services that we received

and the components that we are using okay and guys again on this cheat sheet

that I’ll be putting out I’m going to give you the website directly to Medicare so you can type in the codes

and it’ll tell you it’s public it’s public it’s open to the public right and I’ve done this sometimes with my parents

uh Insurance bills and everything like that just checking to make sure and saying okay why do we have three of the same thing here labeled what does that

mean okay and then I tell people if there’s something on there that you can’t figure out you need to call your

clinician and ask them to explain this to you right it could be one of two things that you just simply didn’t

recognize it and your clinician can explain the why for example the 599 code that’s a perfect example right there

because it may show up as unspecified and you’re sitting there going what does this mean right um it could be that

there may have been a billing mistake those happen frequently in healthcare where a secretary who perhaps does not

have the right training or a clinician put the wrong bill in that happened to me on a couple of occasions right so

it’s good for you to double check in these things yes how many of you guys check your insurance

bills you can check your insurance bill y I do yeah and you’re right it’s just doing your due diligence I think and we

talk about it a lot cozy it’s like you got to be your own best Advocate because nobody’s gonna do it for you like you

have to be in charge of that nobody else is going to look at that like it only comes to you so I mean I I you didn’t

used to in the beginning days of being an UT I just like oh it was pages of pages of what do they call eobs

explanation benefits and I was like oh my God I’m just overwhelmed with these things again bilateral akbk on both legs

so I was getting a ton of those line items and not knowing what to do with them but you’re right it’s great to just

look at it understand it and know what what they’re billing you for really yeah no prosthetic componentry is expensive I

don’t need to tell anybody else out there watching you know it’s it’s thousands and thousands of dollars so you want to make sure that you’re

getting what you what you paid for definitely for sure um so let’s talk a little bit I can’t wait to hear what

Brian has to say me too so tell us a little bit about why is this L code I

mean obviously now we have a specific L code wait I didn’t even make the official announcement did I make the official announcement Revo fit now has

an official L code you just did I just

did I think I put the real stuff in here the real the real caffeine in here did we share the number do we need to share

the exact number here yes please because I want people to write this down so share the number it’s l

5783 and um I guess before I get too deep into it every L code or every hick piix level two code which that is comes

with a description and the description if I can get all the the language right is addition to so it’s it’s additional

to all base socket codes so if you’re a new socket or replacement socket so it’s addition to lower extremity user

adjustable mechanical residual limb volume management system and every

single word in that description um I would say we intentionally architected to

describe the use of the system the benefits of the system and the fact that it truly is a system that gets

integrated into your prosthetic socket so it’s a it’s it’s quite a win and we’re we’re pretty pretty dog on excited

about it and guys I typed it in there because if you have a Post-It note I want you to write it in your Post-It

note and stick it in your pocket because at some point many of you are having conversations with your prst as to

whether or not you are a candidate for the revo fit system and this information takes time to trickle down you have some

prst that they’re really on it and they’re reading all the news as it comes in and some prst just because of the

nature of the fact that they’re very busy in their clinics they may not have heard the news yet that there is a code

uh and I know some of you have come to me in the past and said yeah my prosus said my insurance wouldn’t cover it so we didn’t get to do it etc etc you can

take this to your proetus now and say Here’s the code let’s talk right right so what is involved with getting an l-

code approved it’s it’s not a just a one checkbox application yeah you know the

the one of the most interesting things about answering that question is the first thing you have to do is decide if you want to go for it and we spent years

talking oursel out of going for it because there’s there’s three things that happen you you either get a code or

well you could go to the pedac first which is another acronym that you didn’t mention okay pedac is a committee that

decides whether or not a technology or a solution or a manufactured product fits

into the existing code set so that’s their whole job is to figure out if we bring a new a new widget a new foot a

new pylon a new anything to the market the first thing that usually happens is that committee which is a contracted

committee understands the the Deep the deepest darkest secrets of all the codes that are out there and all the

descriptions and they decide it fits or doesn’t fit well so when they decide that it doesn’t fit then you have to go

seek a new code the The Perils of seeking a new code include you may not get one and then what so then you’re

relegated that’s when the 5999 code or any any miscellaneous code becomes the

place you go to die because basically they’ve said you’re not worthy of being coded um at least that’s the way we

looked at it the second thing that could happen you get your code but you’re not covered why in the world would they give

you a code and not cover it I don’t know but that is that is a pitfall they could

say it’s a worthy product but as a Medicare population we don’t see this benefiting Medicare but they’ll give it

the Credence of the fact that it wasn’t part of an existing code and they’ll say it’s worthwhile but maybe they don’t

think that the Medicare population needs it because that’s what CMS is mostly concerned with is covering

Pati the third thing that might happen is maybe you get the code maybe you’re covered and then they set the allowable

and it might be less than it cost you to bring the product to Market so if you if you take all those things

you look at the road ahead and you go is it worth it it is that’s a daunting task

and so we talked ourselves out of it for years Coy and group and it was um and finally we said one day you know what we

got to go for it we don’t do anything by the rules at click medical we’re we’re an innovator we think if something needs to be done we’re going to go figure out

how to do it and we went for it and we got we got great counsel from good friends in the industry I’ve seen a

couple names here on the chat of folks that helped us tell the stories that they see as clinicians that they have

delivered for great patient outcomes and and you go for it and then the process is it takes a lot of time to write the

application provide the evidence prove that you’re a market worthy product and

you go through that that Gauntlet and then it takes another four to six months to find out if if anybody has college

kids it’s like the FAFSA your kids going to college and you have no idea what black hole it went

into and you find out later that you miss to field and you’re like um and so you go through that

process you find out that there’s a preliminary decision you go through another process there’s a final decision

and then time elapses and then and then voila April 1st 2024 L 5783 was

born wow and more things have to happen after that we won’t go into all that detail but now they have to Define it

further with policy um for Medicare and for all the different jurisdictions of Medicare and then and then the dominoes

will fall what the VA will do what the Medicare Advantage plans will do what the commercial plans will do and then

you know workers comp tends to be workers comp but they could you know they could do some things too so it’s a

it’s every day is a new thing to learn I I’m learning so much every day and what you said earlier about find an expert in

coding I dare you you will find people with expertise

that we don’t have here but to know the whole system it’s like I don’t know I think it’s not possible no no and and I

yeah there there’s so much even just in the simple explanation that I gave that I missed right there so so you mentioned

earlier about the importance of the 5999 code that it’s not always necessarily

the enemy yeah the intention I think the

intention of that code is a really good one which is if we can’t find a place for you then we’ll give you an

opportunity to document the the indications that sort of um justify

medical necessity of something new that’s not otherwise coded and we did that for years we didn’t have pedac

never said I’m sorry for the the acronym I said it earlier we’re just gonna have to go with it but the those folks never

said click medical Revo fit is not part of the code set we just decided to say

you know what we know we’re not part of it so the L5 999 for lower extremity or L 7499 for upper extremity is the way to

go and and and many of you out there who are practitioners if you ever build a

Revo fit system on the L 5999 or 7499 code thank you because in doing so you

fought it you probably held your cash up for north of 90 days I’m guessing closer to six plus months and if you if you got

it through Medicare and got paid you put precedent in the system that allowed us to go have them see history when we

asked for them to recognize not only the value of the product but the value of reimbursement to the practitioner and it

worked if there’s no history of reimbursement they don’t have near as many data points to look at and then

you’re really in danger of getting that really really crummy um allowable so

that that’s a good so and it’s hard because all the you could get denied it denies the whole claim you’re you’re

you’re held up it takes time and energy to go fight it but for for for those of us on this side of the fence as

innovators the new technology can’t get to Market without everybody kind of

pushing it through pulling in the same direction you know and man we had we had such incredible support everybody was

like what can we do testimonials photos um we we would get people to send us

information that that seem to work when they would code with the 99 code soow it

allowed us to tune our language to say you know the doctor notes need to indicate for things that volume

management solves for which Lou you’re the one that can talk about that way better than I could

right like why would you need that for to go about your day in a way that’s um that’s better than otherwise absolutely

I’ve been blessed with some really great people in my life that have helped me along the way with understanding the

terminology for one because the terminology is like once you understand the language you kind of know how to

navigate the system but I talk about it a lot it’s it’s learning how to navigate the Health Care system and for me I’ve

been doing it for 17 years now so I’ve kind of a veteran at it but for those that don’t really know the

terminology you know or how to do it because I think that most importantly you have to justify why you’re even

wanting this device and for me it was like well my practitioner Works in Los

Angeles and I live in Santa Barbara that’s three hours away one way so for me to go make a micro adjustment you

know that takes about 20 minutes to do like that doesn’t make a lot of sense for me to do that day trip and that’s

where I found a lot of my life just being so much easier not to mention less

skin breakdown less redness and tenderness of my limb so the overall health improved with the adjustability

but I can give you a perfect example that I often share with people you know I was doing a lot of travel and so if

anybody that’s an NP is flying a lot they understand that up in the air that leg will start to swell just like your

feet will and for me you know I was often going to Florida Co and I was traveling from here and so two and a

half hours into that 4our segment to Dallas really U my leg was pounding

inside of there now get this so before I had these rigid sockets right that I

would literally have to take off my prosthetic limb I’m on the plane now like sitting next to people I don’t know

and I’m having to like say sorry like I’m GNA put my leg here do you mind in addition

like it was hard for me to get that socket back on once it was time for me to leave the plane and so what I ended

up doing was like okay I always want the right seat of the plane so that I could put my prosthetic up against the window

there and and then I would just kind of you know shed these layers of socks off

well once I had adjustability all I had to do was reach down turn that dial that actually bought me like two extra hours

of flight time and then when was time to go I would literally tighten that dial up stand up and go like it was a game

Cher just for my travel alone but you know these are just little things that I

had to kind of discover um in my daily life to see the true benefits of adjustability yep no and Debbie says my

Pro Lou my prosus is three and a half hours each way I travel internationally every month travel is rough and you had

me at click a new fan right there I’ve been down Road I know what it’s like yes no

and then for me it’s also just just the simple things of you don’t have to take your pant leg off you can adjust it

through the pant leg um but it’s not so high profile like I love the new with the new click Rael it’s like a lower

profile so it doesn’t stick out so much but you can still adjust it through the pant leg so I don’t know small things

like that um Beth had a great question she said would a person who does not have volume issues benefit from a Revo

you want to take that one look or Brian go ahead oh yeah you want me to answer go for it and I’ll chime in would

a person St state it again would a person without limb volume fluctuation

issues yes yes yes yes and I go back to skin breakdown redness irritation the

limb like in being in that uh so before with the rigid socket like your Lim would move around in there um just

having that tightness will keep you SEC secure I still wear sock P don’t get me wrong like I still wear a three play but

I’m not changing them out throughout the day anymore and plus I’m not having to put them in my pocket either you know

like who wants to carry around sock Plies with them like I don’t I don’t I don’t want to do that so I think yes I

would say yes to that answer you could still get a lot of benefits from it number one being the skin breakdown and

redness and irritation like that’s probably the biggest thing yeah and the other one that that comes to mind for me

is um you know the res ual limb shape can be um somewhat bulbous at the distal

end and yeah at the distal end and what could happen is in order to get that

socket easily dawned safely dawned sometimes just opening the socket up can allow you to safe you know safely and

effectively down the socket and then close either the panel or close the hinge door um or maybe it’s a gap kind

of an opening and there’s lots of socket designs that that that allow for that and it’s a huge deal and then it sort of

serves is more of an anatom anatomical suspension than as a volume management

system but because of the shape and because of the the volume change as you as you move up and down the limb it’s a

great solution for that yeah yep I was just gonna say that the bulb as end and then also one a couple viewers have told

me that it’s just in the morning when they have trouble getting into their socket because their limb is puppy and they don’t have to do the

dance socket so they can just go in and then throughout the day just adjust it just those little adjustments

yeah um so Lou you were gonna say something I was going to say something I just lost train of thought so that’s how

that’s how fast it goes when you’re my age um so we were talking about the the benefits of adjustability and

fluctuation come back to me I I’ll have it I will we’ll take Emily’s question while you keep while you get that train

of thought back Emily says how much weight does adjustability add to the socket so I can show you 70 something

grams right Brian yeah this much it’s actually not a lot it’s

something like 7 72 or 74 grams right not to the point where you could feel it

really I don’t feel it and I I do want to clarify because there’s always a little bit of confusion with this when when people are first learning about the

revo fit the revo fit is a kit right so it literally comes in a box and all of

the pieces that your prostatus needs to build the adjustability into your socket

is in the box so it’s the the cording I don’t even know what they fish name as I always call it the chord lece Y and then

the whether it’s the boa dial or the click reel The Click reel is what we’re using nowadays right so your prosthetist

is still the one making the socket they are still the ones in control of making that socket Soup To Nuts they’re using

the items in this kit to build the adjustability in does that make sense guys so I always like to clarify that

because people sometimes think um that the socket is made by click medical full socket itself and it’s not which in my

opinion is kind of a good thing because it means that your prosus who knows your limb the best they’re the ones who are making your socket and they’re putting

the adjustability in right there at their Clinic Coy I’ll add one thing for the for the um for added weight it the

socket designs impact that right so when the the tubing that the revo fit system

utilizes for the lace to travel through often times is is sandwiched between the

two different walls so it’s a it’s called a double amination for you prosthetists and technicians you know

that maybe the rest of us folks that don’t make these sockets don’t always know that but extra material can add

some weight but if weight is an issue there there are techniques that you can reduce the amount of material in those

laminations you can do sing they call it a single shot lamination and there are also techniques where the lace tubing

itself actually improves the structure of the socket frame such that other materials can be

reduced so you get increased strength because of the tubing itself and I’m getting way I’m getting a little bit no

I like I know this but you know you know Joe I’ve heard Joe talk about this many times you actually can use the the um

the layups to increase strength reduce materials so you’re you’re kind of trading weight for weight it can add a

little bit but I would say that’s not a problem we hear about I did see another question about you know how far the dial

sticks up off the socket frame and does that c I mean it it you can’t hide it it does

stick up off the socket frame but there are ways you can essentially strategically place it so it’s either

not in the way uh you can mount it where the where the dist end of the socket begins to curve you put it in a place

that’s easy to get to that doesn’t interfere with motorcycle riding or bicycle riding or whatever and these are

all the decisions the prosthetist needs to make when working with the patient on what do you want to accomplish once

you’re in your in your prosthesis what do you do what does your life look like what does your work look like

and while it sticks up a little bit off the frame it is um the value exceeds the

inconvenience of having kind of a little bit extra you know a little bit of extra Contour there that’s what we hear most

of the time and there we go so Jamie posted that weight there as well the real weight is 71 grams um Beth is

asking does it matter whether or not it’s a suction or pin suspension referring to the suspension um and I do

want to add something guys I always say like sometimes some of the components use if they have a little bit of extra

weight if the socket is built well and there is good suspension and it’s well connected to your leg then 71 grams is

not going to be something you’re going to notice um so going back to the best question does it matter whether or not

it’s suction or pin suspension no it’s compatible with

either so it’s compatible with all the different suspension systems and then let’s see let me just show you guys M

mine real quick cuz mine has the both it has a vacuum has vacuum and has the the hinge

design which would come back here I don’t have that one L so can you show them how that hinges out because that’s

the one I don’t have so this just I’m just gonna release it a little bit I’m

just going to push out so it can come out so this is what it looks like right there I mean it can go further than that

but I mean that’s about as far as like I like it to go and you know what it’s got

is so so I have a flexible inner you could see that and then I have the hinge

and then I also have uh suction here so it’s kind of got like the best of all

worlds here and and on top of that so I use the the liners that have the ring

the adjustable ring but this works great for what I’m doing I’m not trying to like run any marathons or anything crazy

I’m just walking around walking well cozy right because that’s really number one thing walking well and uh in living

my life and it fits me so I’m happy very good uh Scott ask a very good question

he says is the weight limit still low well low to me I’m over 500 pounds so lots of options are not

available um and Jamie thankfully jumped in and said yes that basically talking to your proetus about possibly using two

reels uh to increase the weight limit for adjustability that’s right so that seems to be a good a good solution there

harsh asks is it better for an AK or a K the

adjustability oh good question I’ve never had that question before I’m like well there’s there’s many many designs

for both AK and BK and I would say um the volume volume management is

volume management and so you’ll see designs for um you’ll oftentimes you’ll see a gap sort of a design for the where

the posterior aspect of the socket is open for yeah Bingo for for seated

comfort and whatnot and rather than have a sort of a Dacron strap or something fixed on there why not have a little bit

of adjustability so that if you’re seated for a while you can actually loosen the socket um we do see a lot of

um you know we see a lot of sort of fleshy AK type systems where there’s

really a lot of volume to manage as as opposed to a BK which is a a sort of a

smaller part of the anatomy so it’s I think I’m going to say it’s 50/50 it’s equally effective it really just

depends on the sort of the patient needs their anatomical indications and weaknesses

and sensitivities and it’s it’s an effective system for both yep absolutely and let’s see we got

sorry guys I’m scrolling through all the questions here by the way guys if for whatever reason I miss your question or

you think of a question after we stop going live you can email me your questions directly at coy coy talks.com

and if it’s a question I don’t know answer to then I’m going to go talk to the experts and get the answer from them

uh let’s see did we get all the questions we did pretty good all right guys time for our last giveaway of the

evening Jamie is going to post another link and the question once she posts

that link is what is the L code for the revoit

system so she’s gonna post a link there it is awesome so go to that

website go to the click Medical website show my sponsors a little bit love there and let us know what is the L code for

the revoit system drum roll funny story while you’re drum

rolling so we were we knew we were getting a new code but we didn’t know what the actual number was and I’m not

going to spoil it by telling it to you right this moment but so before the show we decided Well we don’t know the actual

code so we just called it the revo code and Jamie got us a neon sign that

said Revo code and the dog on thing was so bright you had to wear sunglasses to

look at it very nice very nice there we go we got Scott coming in Pam coming in and I

realized I forgot to Jamie says Revo code Revo code that’s right she’s

posting that in there yeah wishful thinking and you know what using the Law of Attraction too we

know what we wanted that’s right

all right we’re getting a few people chiming in with the answers who’s going to get the third

Yeti mug I got the old I got the OG one I love that one too it’s a great one

yeah all right I have the travel one it folds up and you can just put it in your

pocket it’s the Koozie one the Koozie all right guys Carrie says just

tuning in we’ll check this out on the replay thank you cozy oh Carrie I can’t use you are definitely going to want to check this replay out and guys just as a

reminder I have my new blog and my new podcast and yes that is absolutely a Shameless plug uh you can find it on my

Coy talks website right there so I’m putting everything on my website so it’s one place that you can go to to find it

we’re going to be uploading this show on to my podcast on Friday and then guys

here’s here’s where I really want you to keep this in mind Monday I will be releasing the blog about cracking the

insurance code everything that we talked about tonight so you can read it with your morning coffee and then my cheat sheet which this is the cheat sheet this

is what I’ve been using all night right here no shame no shame all the initials all that kind of fun stuff so that if

you have when you keep this on your fridge and you get your next insurance bill you can refer to this okay because

I’ll put the website on here as to where you can look up all the codes

right uh let’s see oh Beth says she lost her feed for a few minutes can Revo be used for both suction and pin lock yes

it can be yes yes um so van Gregory asks not that I am an

upper extremity ampute you may have addressed this already um but is there an adjustable kit for upper

extremities yeah great question um Revo fit gets used in upper extremity quite a lot as does Revol lock as a suspension

system they’re they’re both compatible you know the for for smaller

upper extremity socket you know the curves are much more severe for a for an arm than a leg typically so there there

tends to be some some creative you know deciding of how to get the dial in a

place where it’s most effective but absolutely we see a lot of it we even see some of the lower powered dials some

of the lacers and whatnot get used in upper extremity in upper extremity sockets as well so yeah we have great

resources on our website click Academy there are advanced advanced design um

case studies that have some upper extremity designs and we can always answer questions if you have more specific questions but for sure and

we’re so confident in that that we’re working right now with the group of experts in the industry to begin our

application process for an upper extremity code for revoit so stay tuned oh nice very

nice nice so guys I’ve got also the names of our two winners our last two winners so for the the previous giveaway

that we did we’ve got Pam nunziato congratulations Pam and then for this

one the one who got the L code is Barbara wood so uh folks thank you so much for being uh participating in these

giveaways I will try to hunt you down afterwards but if you can if you can if you can jump the gun on that one for me

and send me your addresses to this email address and click medical will be sending you your Yeti mugs all right

guys I think we grabbed all the questions this was really good I learned a lot this evening so um thank you both

um for being on the show for your time and for your expertise uh with everything with insurance so Brian I’m sending um all

the insurance questions from now on to you let me just tell you and tell

everyone and if you want to add this to your to your cheat sheet it might be good on our website underneath the revofit product

page so it’s it’s www clicked. yep forward revoit we have a

section on insurance and coding and um I worked on all of it and

I am not like I said an expert nor am I nor am I um an insurance coder but so

it’s in it’s in layman’s terms it’s really good materials it’s great for prosthetists it could some of it could be very good for for uh ampts that want

to understand the frequently asked questions of of the code itself a lot of

it’s it’s it’s certainly specific to Revo fit but there’s good nuggets in there just to understand you know what

has to be done to get your your uh the parts of your prosthesis PID for No it’s

it’s already I was scribbling away as you were saying it so I will be putting that on my cheat sheet for sure thank

you um and I do want to say a special thank you to Jamie she is my gal behind the scenes uh from click medical she is

the one posting everything and running back and forth and getting everything uh squared away so thank you Jamie for all

your help and to The Click medical team for the continued support for the coy talk show um so guys please share this

uh show out to your support groups I really rely upon your your generosity to do that to help spread the word about

the show go listen to the podcast it’s always like I said repetition is the mother of memory sometimes it’s good to

hear this information a couple of times and then go read the blog so I think I did all my plugging I did it all I think

we got everything covered right there all right guys as always thank you for letting us be a part of your lives this evening and we will see you next week

same bat Time same bat Channel God bless guys right bye guys