The variety of walking cast that your doctor provides you with significantly impacts your treatment. Total Contact Casting (TCC): The Gold Standard of Care. Total contact casting (TCC) has long been referred to as the “gold standard” for treating non-infected, neuropathic foot ulcerations. 11-21 Of the seven randomized, controlled studies, … Do not let your child walk on the cast or splint. To help dry the outside of the cast or splint, you can expose it to sunlight or use a hairdryer on the cool setting. Walking boots are great when the condition that you are treating is safe to remove from the immobilization temporarily, eg … Our purpose is to present the basic technique of applying a total contact cast and to discuss the evidence behind TCC. Offloading the neuropathic foot is the cornerstone of diabetic wound management, and the total contact cast (TCC) has been recognized as the “gold standard” for treatment for decades. There are currently seven randomized, controlled trials that have validated the TCC’s efficacy as well as a meta-analysis with 498 patients that noted healing rates of 88 percent in a mean of 43 days. The total weight of a large cast iron bathtub, full of water with an adult bather, can exceed 1,000 pounds. Reducing pressure on the wound by taking weight off the foot has proven to be very effective in DFU treatment. @naturesgurl3 -- I think that while you could wear it in the shower, the whole point of wearing an air cast is that you can take it off, so that you can shower without it. 2-7 The success of the TCC has been attributed to its ability to “unload” the plantar foot and maintain immobilization by the non-removable cast. The ease of application can lead to fewer complications. This is designed to make the boot a total contact device to prevent movement of the foot and ankle providing a more precise fit. No prefabricated device is likely ever to match its combination of protection completely from both normal and shear forces, and it approaches as near to a guarantee of patient compliance as any offloading technique can. Cast structure at the ulcer site provides one major variance, i.e., should the cast create total contact with the entire plantar surface of the foot or should the wound be isolated? Physician Office and Hospital Outpatient Setting – Coding RESEARCH QUESTION . Sources: Foot Ulcers and the Total Contact Cast. KEY MESSAGE . Total contact casting (TCC) is a specially designed cast designed to take weight off of the foot (off-loading) in patients with diabetic foot ulcers (DFUs). American Orthopaedic Foot and Ankle Society. This should take away most of the objection about billing debridement and Total Contact Casting. While in a walking cast, exercise for the lower body in addition to the upper body can be continued while recovering from a leg, ankle or foot injury. Physiotherapy TCC-EZ® is a lightweight, one-piece, roll on, woven total contact cast that offers an easy way to provide the gold standard of care for the management of diabetic foot ulcers. However, Commercial payers may consider separate payment with appropriate modifier. CMS still does not pay for debridement and TCC when the 11042 or 11043 codes are used. If so, you can find many more like it here. The cast relieves the pressure on the prominent areas of the foot, permitting the ulcers to heal. So although you probably could wear one in the shower, you really shouldn't, and there's really no reason not to take it off -- I mean, that's what they are designed to do. Try to walk as normally as possible even if you are using a walking aid. This is for good reason. They are similar: A cast and a walking boot are similar and accomplish many of the same goals. Did you enjoy this article? CMS still does not pay for debridement and TCC when the 11042 or 11043 codes are used. TCC-EZ® Total Contact Cast System,The ease of the market leading TCC-EZ® makes its use practical in clinical settings. Please call one of your Sternal Support Solution contacts to walk through how this works. The hospital staff will tell you how much weight you can put through your leg and provide you with a walking aid if necessary. As per NCCI edits total contact cast application (29445) cannot be billed separately from a debridement (97597) when treating the same ulceration/same anatomical location for medicare as of above scenario. Although the benefits of total contact casting for healing plantar neuropathic ulcers are consistent throughout a large body of available literature, the method of cast application varies (1–17). It is recommended for the patient to conduct HBO therapy and then change the cast. T echnique Step 1: Appropriately dress the wound Dressing should be keep to a minimum to prevent bunching or cast shifting. The gold standard for offloading therapy is total contact casting (TCC). The total contact cast (TCC) is an effective intervention to reduce plantar pressure in patients with diabetes and a plantar forefoot ulcer. Debridement – Medicare does pay for Total Contact Casting when applied after debridement codes 97597 and 97598 are used. In order to gain the most benefit with the least amount of risk one must consider several key variables and, most importantly, must consider the patient as a whole. 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