Medicaid, providers spar over coding

Tuesday, March 31, 2009

ATLANTA--Relations between rehab providers and Medicaid officials have heated up, as they continue to debate the merits of K0108, a miscellaneous code for wheelchair components and accessories.

In February, rehab providers enlisted Dr. Doran Edwards, the  SADMERC director turned consultant, to help them get through to Medicaid.

“So far, the state has been resisting him, which is discouraging, because we feel there couldn’t be a better coding expert,” said Weesie Walker, who manages the National Seating & Mobility branch in Atlanta.

Medicaid officials want to eliminate K0108. They’ve seen an increasing number of claims with that code, and those claims take longer to process and price. Instead, they want individual codes.

Rehab providers argue that’s not quite possible.

“There are way too many products with low utilization that don’t warrant individual codes,” said Laura Cohen, co-coordinator of The Clinician Task Force in Atlanta.

Rehab providers admit they’re using K0108 more than usual, but they have no choice, they say. The reason: Medicaid officials have “closed” some codes while they change claims processors.

Without K0108, patients won’t have access to certain  products and technologies, rehab providers argue.

In January, rehab providers discovered that Medicaid’s 2009 policy manual eliminated K0108. They got some relief later that same month, when Medicaid backed off the change, but they know the fight’s not over.

“We’re just trying to keep the lines of communication open,” said Chip Fiske, chairman of the recently formed Georgia Rehab Technology Council.