Wheelchair documentation falls short, Noridian says

Monday, June 8, 2009

FARGO, N.D. – After monitoring claim activity for standard power wheelchairs, Noridian Administrative Services, the DME MAC for Jurisdiction D, found “documentation submitted (was) insufficient to support even the basic coverage criteria.”

In a June 8 posting, Noridian stated that documentation for K0823s lacked the following:

•    Mobility-related activities of daily living (MRADLs) limitations in detail.

•    Whether canes and walkers were insufficient.

•    Whether the beneficiary had sufficient upper extremity function to self-propel a manual wheelchair in the home to perform his or her MRADLs.

•    Whether a walker or manual wheelchair had been trialed and the results of that trail.

•    Whether the beneficiary was unable to use a scooter.

Documentation should also include, according to Noridian:

•    Strength levels and degrees of range of motion of the beneficiary’s upper and lower extremities.

•    Coordination.

•    Transferring abilities: self, assist of how many or use of assistive devices.

•    Endurance level.

•    Pain rating and how performance of MRADLs impacts the pain rating.

In the bulletin, Noridian stated that it continues to see the use of supplier-generated forms. It reminded providers that “forms produced by the supplier for the face-to-face mobility exam do not record a complete medical exam and thus do not provide enough detailed information to adequately describe the medical necessity for the power mobility device in the beneficiary’s home and are insufficient to meet the statutory requirements.”

Noridian announced earlier this year that high error rates for K0823s had caught its attention. It notified providers that they should be prepared to supply additional documentation for these power wheelchairs: Group 2 standard, captain’s chair, patient weight capacity up to and including 300 pounds.

To read the full bulletin: