Coding picture incomplete

Friday, November 30, 2007

WASHINGTON - The rehab industry would prefer the SADMERC to adopt 10 "builder" codes for manual wheelchairs, but until it sees coverage criteria and pricing, it won't know what to think, sources said.
"The codes are only one piece of the puzzle," said Seth Johnson, vice president of government affairs for Pride Mobility Products. "We need to see all three pieces of the puzzle before we'll know whether one piece fits when you apply it across the board."
If the industry sounds cautious, it is. When the SADMERC revamped the power mobility benefit in 2005, the industry was OK with the codes the carrier developed, but it had big problems with the accompanying coverage criteria and pricing.
If the SADMERC opts for the builder model, providers would use one of 10 codes and then add options and accessories to develop a wheelchair to fit an individual's needs.
"It's the most professional way to do it," said Simon Margolis, executive director of NRRTS. "As an RTS, you could say, 'Here are the choices we have for bases; this is how we can build up from there; and this is how much it costs.' You don't have to figure out how you can get everything you need for a certain price."
Another option proposed by the SADMERC: 40 codes in 10 different categories depending on weight capacity--a similar model to power wheelchair codes.
"That would just add to the chaos of providers, therapists and physicians still trying to grasp power wheelchair codes," said Cindi Petito, owner of Seating Solutions in Jacksonville, Fla.