Billing

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Saturday, January 31, 2004

WASHINGTON - The largest set of new HCPCS codes ever for power wheelchair seating and accessories went into effect Jan. 1.
J. Keiderling

Rehab providers must now use 53 new E codes instead of the K0108 miscellaneous code for the designated items. The codes cover, among other things, power tilt-and-recline systems, leg rests, anti-rollback devices, batteries, power chair drive-control devices, shock absorbers, anti-tipping devices, cylinder tank carriers and zero pressure tubes.

The biggest challenge for providers will be adjusting to the new codes and incorporating them into their day-to-day operations. That includes updating computer systems to recognize the new codes. Providers also must review product lines to make sure the new codes, especially those that include high- and low-end items, offer adequate reimbursement for all covered products, sources say.

Roxann Reid, director of reimbursement for ATG New England, a rehab company in Newington, Conn., called the new codes an aggravation that providers will adjust to.

“[Providers] are trying to determine how CMS arrived at an allowable for a certain code, and why this product fits this code and this one doesn’t,” added Jerry Keiderling, vice president of the VGM Group’s U.S. Rehab. “There have always been those questions. People who are doing rehab on a daily basis and doing it well will learn those codes easily.”

On the plus side, using fewer miscellaneous codes, which generally require additional supporting documentation, should simplify billing and eliminate some denials, said Scott Pickett, manager of sales and technical support for Whitmyer Biomechanix, a manufacture of wheelchair head rests in Tallahassee, Fla.

While some manufactures will ask the SADMERC to assign their products a specific code, many will not, said reimbursement expert Claudia Amortegui, president of the Orion Group.

Those that don’t - either because they don’t have the time or because the proper coding is obvious - will work closely with provider customers to make sure reimbursement claims use the correct code, she said.

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