The SADMERC lays E0192 to rest

Saturday, July 31, 2004

WASHINGTON - Twenty new codes covering wheelchair seat cushions, back systems and some accessories went into effect July 1, but providers have 90 days before they must begin using them.

The new codes come with more specific coverage criteria and descriptions addressing, among other things, height parameters and size. Notably, five new K codes have been created for products previously grouped into E0192, which covers about 90% of all wheelchair seat cushions.

“Because E0192 had so little definition, you could argue that anything that was a seat cushion was an E0192 product,” said Tom Borcherding, the Roho Group’s senior vice president, global medical sales. “Everything at all price levels and all levels of clinical values ended up with the same reimbursement code. You had over utilization of certain technologies based on the fundamental nature of allowables and profit motives.”

By Oct. 1, CMS and the SADMERC must assign products to the codes and develop allowables. Provided they do that appropriately, “this will be a very good policy,” Borcherding said.

“Any time they provide a code that is more specific than a miscellaneous, it is a good thing for us,” said Roxann Reid, director of reimbursement for ATG New England. “The possibility of a clean claim processing the first time around is way higher.”

Among the new codes is K0669, which is akin to a miscellaneous code and intended for products that have not been reviewed by the SADMERC and require individual consideration.

Borcherding called K0669 a “dangerous code for providers.”

“I think it will be a stretch that the SADMERC will put it through and pay for it,” he said. “They are going to say, ‘No, the product needs to come through for review and be properly classified.’”