Sept. 1 rehab coding meeting encourages industry

Monday, September 6, 2004

September 7, 2004

WASHINGTON - CMS and the industry were on the same side of the aisle last week at the Sept. 1 public hearing on power wheelchair coding, a meeting that 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 has recently 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 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.
"[CMS] recognized that they are, in fact, making decisions that go beyond Medicare beneficiaries - that they really do, because of HIPAA, have a role in all payment sources," said Lipka.
Both Johnson and Lipka said CMS seems to be receptive to industry feedback and that the 33 codes are not, at this point, "set in stone."
"There was good dialogue between CMS and the industry. They are clearly looking for additional input," said Johnson.
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.
"That's a lot of work that they have to do between now and then, and it is an ambitious time table," said Johnson.