Transition delays wheelchair coding project

Sunday, August 31, 2008

COLUMBIA, S.C.--Revisions to the manual wheelchair codes could still be a long time coming, depending on whether CMS makes them a priority for a new contractor.

Palmetto GBA, the Statistical Analysis DME Regional Carrier (SADMERC), headed up by well-liked medical director Dr. Doran Edwards, has made significant progress in revising manual wheelchair codes in the past few years. But in August, CMS replaced Palmetto with Noridian Services, and the SADMERC became the Pricing, Data Analysis and Coding Contractor (PDAC).

Before the transition, the word on the street was that the new codes would be released in January.

“There’s no way to predict at this point, but I cannot imagine January is a reasonable expectation,” said Rita Hostak, vice president of government relations for Sunrise Medical. “It depends on whether CMS is motivated to move this project forward and how fast.”

The industry seeks to revise the manual wheelchair codes to better reflect advances in technology and simplify claims processing.

The SADMERC had been playing with two formats for the revised manual wheelchair codes: 10 “builder” codes with add-ons for options and accessories; or 40 codes in 10 categories, depending on weight capacity.

Industry sources, including Edwards, don’t expect Noridian to reinvent the wheel.

“It is anticipated that the PDAC will take the current templates and continue the work,” he said. “However, nothing prevents them from taking a fresh look at the data and devising a new plan.”

Even though the transition will probably mean a delay, provider Tim Pederson still thinks Noridian, also the DME Medicare Administrative Contractor (MAC) for Jurisdiction D, will get the job done eventually, and get it done well.

“After the initial hiccups that Noridian had with assuming the Jurisdiction D contract, they have been good to work with,” said Pederson, CEO of WestMed Rehab and chair of AAHomecare’s Rehab and Assistive Technology Council (RATC). “They’ll do a good job as the PDAC.”