Draft coding raises red flags

Thursday, January 31, 2002

WASHINGTON - Because the draft of new seating and positioning codes is diagnostically driven, it's raising a red flag with those in the industry, despite being a significant improvement over current codes.

Industry sources say instead of having cushions and seating backs prescribed and reimbursed based on a beneficiary's diagnosis - everything from pressure ulcers to muscular dystrophy - they would like to see them provided based on function.

"You have to think of the patient's needs first and foremost in seating and positioning," said Peggy Walker, director of member education for The VGM Group's U.S. Rehab. "An elderly patient who's very frail may not have a certain diagnosis, but she can't walk, and she can't sit comfortably in a wheelchair 12 to 14 hours a day without a certain cushion."

Medicare extended a comment period on the new seating and positioning codes to the public from Dec. 3 to Jan. 21. It also scheduled public meetings last month in each of the four DMERC regions.
Industry sources say there's no denying seating and positioning codes need revamping, especially as providers move toward billing electronically. They say all cushions, for instance, currently fall into one code, with no parameters describing what each does.
"It's been a long fight just to get to this point," said Dave Williams, director of government relations for the Elyria, Ohio-based Invacare, "CMS is finally acknowledging that cushions are more than just a pad for comfort but a clinical application, as they relate to positioning, pressure relief and skin integrity."

Another red flag for those reviewing the draft is the call for testing - either by simulation or human subject - to ensure the performance characteristics of cushions and seating backs. That, industry sources fear, could prove costly to manufacturers.
But Williams said you're only going to hear those complaints from smaller manufacturers. He said larger manufacturers already test. Even so, Williams said the testing requirement could be problematic because existing standards can't be tested using the protocols the draft lays out. HME