6.0 Therapeutic Services

Definition: The application of clinical services to improve the rehabilitative outcome and/or prosthetic/orthotic use; involves direct contact with patient. This includes the provision of products important for the function, comfort and anatomical finishing of the prosthesis/orthosis. (Refer to appropriate health professional if necessary).

Code	Procedure	Description
1	Provision of essential prosthetic/orthotic product(s)	Provision of prosthetic/orthotic product(s) that are essential to the proper function of the prosthesis/orthosis. These products may include socks (wool, cotton, synthetic, gel, silver, nylon), gel liners, finishing hose, suspension sleeves, prosthetic skins (upper extremity gloves, lower extremity skins), donning sleeves, hook elastics, skin lotions, and batteries. Customization and application of some of these products may be required. Demonstrate donning, care and maintenance.
2	Wound care	Dress wound to allow safe reapplication of prosthesis/orthosis. Record visual image and/or measurements for future reference. Refer to appropriate health professional if necessary. Note: applies strictly to skin issues related directly to prosthetic/orthotic use. Does not include care of other wounds; for example, diabetic ulcers on the contralateral limb.
3	Segment volume management	Instruct patient on appropriate techniques to control body segment volume (e.g. tensor bandaging, compression garments, limb positioning, dietary restrictions, etc.) and how to accommodate fluctuations so as to avoid skin breakdown.
4	Compression therapy	Application of compression garment (shrinker and/or compression bandage) including customization as required. Instructions on wearing schedule, care and maintenance, troubleshooting.  May involve multiple sessions for adjustments/ replacement garments to ensure sufficient compression as body segment volume decreases.
5	Management of skin problems	Skin problems may include abrasions, localized rashes, fungal infections, water blisters, hyperplasia, and friction irritations. Discuss options and provide solutions, if possible, to resolve skin problems.  Advise patient how to use prosthesis/orthosis.  Refer to appropriate health care professional, as necessary. Arrange for follow-up appointment.
6	Emotional counseling	Coach patient on how to improve his/her ability to cope with the social and psychological aspects of functional losses by providing emotional support.  Refer to appropriate health professional if necessary.
7	Body weight management	Provide the patient with techniques to maintain or regulate his/her body weight and/or conditioning. This may include nutritional and fitness counseling.  Refer to appropriate health professional as required.
8	Pain management	Discuss conservative options for pain management: desensitization, mirror therapy, residual limb bandaging, activity, and massage.  Refer to appropriate health care professional for more complex management.
9	Patient matching	Arrange for patient to meet patient(s) with similar circumstances.
10	Smoking cessation program	Coach patient about the negative consequences of smoking.  Refer to appropriate health professional if necessary.
11	Infectious disease protection	Implement recommended infectious disease protocol(s).
12	Digital imaging procedures	Use videotaping and/or photography for the purposes of documentation, research, education, clinical diagnosis and clinical validation of treatment.
13	Advanced gait training program	Implement a gait-training program to teach the patient to safely use his/her prosthesis/orthosis in all aspects of activities of daily living.  May include gait on level ground, uneven surfaces, inclines, stairs and teaching effective falling and recovery techniques for the patient to maximize his/her potential.
14	Advanced training for use of upper extremity prosthesis/orthosis	Training for specific and or advanced tasks needed to utilize upper extremity prosthesis/orthosis. For example: training patient to control and sequence the activation of systems needed to functionally operate a brachial plexus orthosis. Involves multiple sessions.

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