CMS ignores industry’s plea to revamp PWC codes

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Sunday, November 23, 2003

November 24, 2003

WASHINGTON - The industry will enter 2004 with no change in Medicare coding for power wheelchairs, disappointing AAHomecare’s rehab council, which worked long and hard to divide four power codes into six.

AAHomecare's Rehab and Assistive Technology Council, with input from manufacturers and providers, proposed dividing the K0010, K0011, K0012 and K0014 codes into six new codes. The proposed codes more specifically matched a patient’s clinical indicators and condition with the appropriate power chair, said Executive Director Sharon Hildebrandt.

“Our codes would have made it easier to place patients in chairs appropriate for their levels of functioning and the technology available,” she said. “If you had this disability you would fit into this kind of chair.”

CMS OK’d dozens on new HCPCS codes in October. The new codes go into effect Jan. 1. CMS has not told RATC why it denied the new power chair codes.

The largest power wheelchair code, the K0011, desperately needs revamping, say industry watchers, who call it a “dump code” because it includes low-end chairs, high-end chairs and everything in between. By being so broad and reimbursing the same for all chairs, the K0011 code fails woefully to distinguish between differences in technology, they say.

CMS’s failure to adopt the new HCPCS for power chairs is a double whammy. Under HIPAA, managed care companies and state Medicaid departments will use the HCPCS as part of a universal coding system. Now all three payers will be employing inadequate power codes, say industry watchers.

In all, RATC submitted 32 new codes and CMS accepted six, including two for transfer benches and two for wheelchair accessories.

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