Peggy Walker

The functional needs of the patient should be the first thing addressed when deciding what base is truly needed. What item will they need to get from point A to point B and accomplish their daily functional activities?

Regardless of the code that most suppliers want to use, we should all be aware of the pitfalls of cookie molding every patient to the same exact base code. This causes the code to rise and the headlights to go on in the auditing world.

There are a few good basic chairs that are coded other than the K0823 code. In many instances where clients are elderly and truly need a power chair "in the home," something as basic as a Group 1 chair will meet their needs. Even a basic smaller take-apart (K0821 or K0820) will meet most of these patients' individual needs.

I frequently hear: "What is that code? I never heard of it." Understand that there are options other than K0823. I have even had suppliers ask me if it is OK to downgrade to a K0821 because the patient's husband/family member feels the smaller chair would be easier to handle and transport. You do not have to down-code if everything is complete and you have already done the detailed product description. Instead, just correct it and have a physician review it, date it, and then deliver what is actually needed.

The coverage for group 1 and group 2 is basically the same, but there is always the least costly alternative in every policy. Within group 2, there are down-code possibilities, but a group 2 is not supposed to down-code to a group 1.

The group 2 single power options and above, as well as all group 3, group 4, and manual wheelchairs with a push rim activated device, require a PT/OT or physical medicine physician. As of April 1, 2008, these also require a supplier who has a trained ATS or ATP on staff who is directly involved with patient evaluation.

Group 3s are diagnosis-specific related to progressive neuromuscular diseases or conditions. Group 4s and 5s are non-covered. You can use ABNs in many of these situations, but remember to use the new "overflow" modifier of KB for an ABN upgrade, or 99 for something such as a replacement power wheelchair.

F2F is required for all power. The only exception is if a PWC or POV is being replaced due to some type of catastrophic event such as fire/flood/theft, and it is less than 5 years old. Documentation is required on request.

Basic coding and updates are the same except for the basic equipment package items that can now be billed only as replacement on power, such as seat belts and any type of tires. The adjustable height armrests will deny if a power tilt and/or recline is billed.

Peggy Walker, RN, is billing and reimbursement advisor for US Rehab/VGM, Waterloo, Iowa. Walker can be reached via e-mail through the HME Today editor: .