Q. How do I code wheelchair replacement parts?
A. The coding of wheelchair replacement parts can sometimes be confusing to even the most experienced biller. Getting it right is vital because using incorrect codes can delay payments on a claim or can result in unpleasant outcomes in an audit. Some items, such as backs and cushions, are required per policy to receive official coding before they can be provided. The majority of all other parts, however, do not. There are some options out there that providers can use as a resource to help figure out the appropriate code to use when supplying a replacement part.
The first resource a provider should consult is the DMECS page on the SADMERC Website (Located at http://www3.palmettogba.com/dmecs/). Here you can get code descriptions or search for a specific code using keywords like “leg rest.” You can also view whether a specific piece of equipment has received official coding by product category or by manufacturer.
Manufacturers are also a good source of information about coding on a specific replacement part.
One last piece of advice: Many replacement parts simply do not have a specific code; the miscellaneous code K0108 needs to be used in those cases. Miscellaneous codes are both a hassle to bill and, from a Medicare contractor standpoint, to process. While the information that Medicare requires for this code on a claim is greater than normally requested, there are no shortcuts available. Fortunately, today there are far fewer times when K0108 is used than in the past as new codes are continuously developed.