HomeVA ProstheticsVA Handbook 1173.10 - Orthotic Devices and RepairsProcedures

10.3. Procedures

a. Medically prescribed orthotic devices and repairs must be provided in a timely and efficient manner to beneficiaries who are eligible for prosthetic services.

b. Upon receipt of a prescription, an evaluation of the patient by the Orthotist determines the appropriate orthotic device and/or service.

c. The VA Orthotic and Prosthetic Laboratory must provide orthotic devices and repairs to beneficiaries to the fullest extent possible. At facilities not having access to the VA Orthotic and Prosthetic Laboratory or where the laboratory's workload is such that the Orthotic and Prosthetic Laboratory cannot provide prompt service, local contracts are to be awarded to private contractors for procurement. Contract devices must be of high quality and are to be inspected by the Chief, Orthotic and Prosthetic Laboratory, Orthotist designee, or Orthotic Clinic within 30 days of delivery.

d. The Prosthetic and Sensory Aids Service (PSAS) and the Orthotic and Prosthetic Laboratory need to maintain an inventory of the more frequently requested prefabricated orthotic appliances and soft goods that are stocked for immediate issue to eligible beneficiaries. The local medical staff prescribing these items is to be kept informed of their immediate availability.

NOTE: In accordance with a memorandum from the Chief Prosthetics and Clinical Logistics Officer, the maximum level of inventory on hand is not to exceed 30 days or 1 percent of the allotted yearly budget.

e. Facilities requiring the services of a VA located at another facility, must schedule and obtain confirmation of an appointment prior to referring beneficiaries to the laboratory in order to avoid delays and backlogs in the Orthotic and Prosthetic Laboratory's treatment schedule.

f. When a custom device or repair is authorized by a Prosthetic Request (using the Computerized Patient Record System (CPRS)), and is to be done at the VA Orthotic and Prosthetic Laboratory, an OWL is created to document all components, materials, and labor used. Upon completion of the job and delivery of the device, the OWL is completed and a CPRS progress note is entered in the patient's record.

g. Within the OWL Business Practice Guidelines, when a prefabricated orthosis is fitted by the VA Orthotic and Prosthetic Laboratory, the item fitted is to come from "stock issue," and there is no need to create an OWL. The Orthotist must document in a CPRS progress note, all work done and the instructions given to the patient for care and maintenance of the fitted device. Additionally, the electronic consult and/or suspense note are to be closed upon issuance of the device to the patient.

h. Within the OWL Business Practice Guidelines, when a custom appliance or repair is authorized, an OWL must be prepared and the original and a copy forwarded, by the most expeditious means, to the VA Orthotic and Prosthetic Laboratory selected. An OWL must be prepared for each beneficiary for whom an appliance is to be custom fabricated or repaired. If the patient is to receive more than one custom appliance, an OWL needs to be created for each custom item or repair. Once the OWL is closed, this must be posted to the patient's record.

i. Upon receipt of an OWL for a custom appliance or repair, the Orthotic and Prosthetic Laboratory must take the following action:

(1) A "Work Order Number" is automatically assigned during the creation of the OWL work order and can be used to track the progress of the job.

(2) All information on the OWL must be checked for accuracy and the item or services to be furnished, based on the CPRS Consult.

(3) All working time spent on the specific job by one or more practitioners or technicians and all materials used must be entered in the appropriate sections of the OWL (Materials and Labor Sections) record section as the work progresses or upon completion.

(4) Upon completion of the job, the appliance must be reviewed and inspected by the Chief, Orthotic and Prosthetic Laboratory, or Lead Prosthetist or Orthotist, to ensure the accuracy, fit and function of the device. The OWL is then completed and a CPRS progress note is posted to the patient's record.

(5) The Chief, Orthotic and Prosthetic Laboratory, Lead Prosthetist, Orthotist, or designated practitioner, is responsible for computing, as accurately as possible, the actual cost of materials and labor.

(6) If the completed device or repair is to be returned to the requesting VA facility (another station), a copy of the OWL is sent to that station indicating all work done and associated costs for materials and labor. The requesting facility has the responsibility for follow-up.

(7) If the completed appliance or repair is delivered directly to the beneficiary by the VA Orthotic and Prosthetic Laboratory, the following procedures apply:

(a) The date delivered must be completed on the OWL.

(b) The OWL automatically totals material and labor costs as this information is posted to the OWL.

(8) When a VA Orthotic and Prosthetic Laboratory request that work be done by another VA Orthotic or Prosthetic Laboratory involving custom fabrication, the requesting laboratory must prepare the OWL and forward it to the laboratory where the work is to be done. The procedure for processing such requests in the receiving laboratory is essentially the same as that outlined in subparagraph 3i.

(9) When a veteran presents a VA Form 10-2501, Prosthetic Service Card (PSC), to an authorized contract provider (commercial orthotic facility) of their choice, to have repairs made to their appliance, the commercial Orthotic facility submits the invoice for payment to PSAS, who then makes payment using a credit card. NOTE: VA Form 10-2501 authorizes a specific amount for repairs, and to exceed this amount, requires the prior authorization by VA Prosthetic Representative, or designee.

(10) The Orthotist must enter a progress note into the CPRS, which documents all work that was done during a specific appointment for a patient (i.e., casting, fitting, repair, instructions, etc.).


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