SADMERC demistifies new codes

LAS VEGAS -- A driving force behind the 49 new power wheelchair and scooter codes Medicare plans to implement next year talked about the benefits of the new system with a room full of industry stakeholders during last month's Medtrade Spring show. SADMERC Medical Director Dr. Doran Edwards used the Thursday morning forum, sponsored by the National Coalition for Assistive and Rehab Technology, to break down the daunting list of codes and alleviate some provider concerns. "These codes now give providers the whole gamut of chairs to consider when fitting a patient," he said, indicating the elimination of the K0011 code that had become the centerpiece for rehab care. "Now you can better tailor a chair to your patients needs." The new codes will also give providers the leeway to consider their patients' future assistive technology needs as well, Edwards said. The inclusion of common add-ons in the base price will also make billing quicker and easier, which should reduce millions of claim lines. The SADMERC determined what add-ons would be apart of a package by analyzing 260,000 approved power mobility claims. Features that were included in 80% of the claims were included in a package, Edwards explained. Edwards described the functions of many of the codes and highlighted what he called "the liberalization of the policy" that now considers activities of daily living more than ever before. The SADMERC moved away from diagnosis driven criteria, so there is more of an opportunity for individual consideration when fitting a chair. This new philosophy is seen in the standard use and general-purpose use categories. Edwards said the definition of these two entry-level categories is purposefully ambiguous, allowing providers to choose which category may be best for their client's individual needs. He also explained these chairs would not be downcoded, which alleviates a concern that had been prevalent since the codes' publication. This policy, however, hinges on Medicare's national coverage determination, which was expected to be released in April. "I have become the red-headed step child," said Edwards. "Now all you are interested in is the fee schedule and coverage policy." Edwards said he has received little feedback on the 49 new codes and is interested particularly in provider comments. The deadline to submit products to be coded is Sept. 1, and the new code set is expected to take effect Jan. 1, 2006.