Industry gets look at new chair codes

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Thursday, September 30, 2004

WASHINGTON - CMS and the rehab industry appeared to be on the same page during a Sept. 1 public hearing on power wheelchair coding, a meeting attendees called “positive” and “refreshing.”

“They certainly, in my opinion, set my mind at ease quite a bit more,” said Dan Lipka, president of NRRTS. “[CMS] appeared to me that they were very sincere and very much interested in, as they said, getting it right the first time.”

CMS and industry players gathered at the meeting to discuss a SADMERC coding proposal that had expanded from 18 to 33 codes.

The additions included five pediatric codes and a new sub group for lightweight wheelchairs for patients up to 250 pounds, said Seth Johnson, Pride Mobility Product’s vice president of government affairs. The sub groups now are pediatric, lightweight (four codes), standard (nine codes), heavy duty (eight codes), bariatric (four codes) and three miscellaneous.

Johnson said the additions go to great lengths to address the industry’s concerns that the original proposal relied too heavily on data from the elderly Medicare population, which could limit the abilities of the state programs to treat highly disabled, more active or pediatric beneficiaries.

“When the code set is established with an overshadowing of Medicare’s program policy, then you end up overshadowing the flexibility and capability of state Medicaid and private carries to be effective in meeting the needs of their demographic markets,” said Ron Kieschnik, owner of Houston-based Seating Profiles.

The additions also addressed some provider concerns that there was an overwhelming emphasis on patient weight in the code designations. Industry concerns no center primarily on questions of downcoding, the bundling of features and what the allowables will be.

Moving forward, CMS said it hopes to have a more formal proposal based in the industry’s comments by November. That proposal and the work of the Inter-agency Work Group on coverage criteria will then be jointly discussed at an open door forum. The DMERCs will issue an LMRP early next year, with a goal for implementation set for July 2005.
CMS's PWC proposed code revisions
Editor’s note: In addition to the following codes, CMS has proposed a handful of pediatric codes as well as some codes for lightweight wheelchairs .
Standard codes

EXXX1-Portable-Lightweight, Sling/solid seat and sling/solid back (patient weight capacity up to and including 250 pounds) frame motorized/power wheelchair.

EXXX2-Portable-Lightweight, Captain’s Chair (patient weight capacity up to and including 250 pounds) frame motorized/power wheelchair.

EXXX3-Standard, Sling/solid seat and sling/solid back (patient weight capacity up to and including 300 pounds) frame motorized/power wheelchair.

EXXX4 –Standard, Captain’s Chair (patient weight capacity up to and including 300 pounds) frame motorized/power wheelchair.

EXXX5-Standard-Wide, Sling/solid seat and sling/solid back (patient weight capacity up to and including 300 pounds) frame motorized/power wheelchair.

EXXX6 –Standard-Wide, Captain’s Chair (patient weight capacity up to and including 300 pounds) frame motorized/power wheelchair.

EXXX7 –Standard-Rehab, (patient weight capacity up to and including 300 pounds) frame motorized/power wheelchair.

EXXX8-Standard-Wide-Rehab, (patient weight capacity up to and including 300 pounds) frame motorized/power wheelchair

EXXX9- Standard-Rehab-High Activity, (patient weight capacity up to and including 300 pounds) frame motorized/power wheelchair.

Heavy-duty codes

EXX10-Heavy Duty, Sling/solid seat and sling/solid back (patient weight capacity greater than 300 pounds up to and including 450 pounds) weight framemotorized/power wheelchair.

EXX11-Heavy Duty, Captain’s Chair (patient weight capacity greater than 300 pounds up to and including 450 pounds) weight frame motorized/power wheelchair.

EXX12-Heavy Duty-Wide, Sling/solid seat and sling/solid back (patient weight

capacity greater than 300 pounds up to and including 450 pounds) weight frame motorized/power wheelchair

EXX13-Heavy Duty-Rehab, (patient weight capacity greater than 300 pounds up to and including 450 pounds) frame motorized/power wheelchair

EXX14-Heavy Duty-Rehab-High Activity, (patient weight capacity greater than 300 pounds up to and including 450 pounds) frame motorized/power wheelchair.

Bariatric codes

EXX15-Bariatric, Sling/solid seat and solid/sling back (patient weight capacity greater Than 450 pounds up to and including 600 pounds) frame motorized/power wheelchair.

EXX16-Bariatric, Captain’s Chair (patient weight capacity equal to or greater than 450 pounds up to and including 600 pounds) frame motorized/power wheelchair.

EXX17- Power Wheelchair, Bariatric, Rehab (patient weight capacity equal to or greater than 450 pounds up to and including 600 pounds)

EXX18-Power Wheelchair, Not Otherwise Classified

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