Home Health & Hospice Week

CMS, wheelchair industry offer competing power wheelchair code proposals.

Are you ready for a whole new set of power wheelchair HCPCS codes to hit next summer?

Whether you will face seven, 18 or even more new codes will depend on how much the Centers for Medicare & Medicaid Services takes the industry's input into account when generating the new wheelchair coding system.

CMS' proposal: 18 new power wheelchair HCPCS E codes to replace K0010, K0011, K0012 and K0014. The three base groups of adult power wheelchairs would be Standard (which would have six subgroups with nine codes), Heavy Duty (three subgroups with five codes) and Bariatric (two subgroups with three codes), plus a code for "not otherwise specified."

The industry's proposal: seven new E codes - power wheelchairs that are: Non-modular; General Purpose Modular; Positioning Modular; Multi-function Positioning Modular; Active Performance Modular; and Heavyweight Capacity; plus a "not otherwise classified" code.

CMS is undertaking the coding overhaul as part of its Operation Wheeler Dealer crackdown on power wheelchair fraud and abuse. The industry's proposal, which has been in the works for years, was submitted by the National Coalition for Assistive and Rehab Technology (NCART).

CMS and the industry have approached their coding proposals very differently, NCART exedutive director Sharon Hildebrandt tells Eli. The industry bases its proposal on existing wheelchair technology and patients' clinical indicators, while CMS bases its codes - generated by the statistical analysis durable medical equipment regional carrier (SADMERC) - on claims processing, she says.

"Coding is more than claims processing," Hildebrandt maintains. New wheelchair codes should both consider patient needs and lend themselves to straightforward coverage policies - neither of which the CMS proposal does, she argues.

But there are many similarities between the coding proposals, notes Matthew Burke of Burke Medical Equipment Inc. in Chicopee, MA. It bodes well for the industry that CMS seems to have drawn heavily on the pre-existing NCART proposal in formulating its coding system, says Burke, chair of the American Association for Homecare's Re/hab and Assistive Technology advisory council.

Suppliers hope for a compromise between the NCART and CMS proposals. Peggy Walker, billing and reimbursement advisor for Waterloo, IA-based rehab network U.S. Rehab, favors the NCART proposal because it focuses on functionality. "That's the way it should be," Walker says.

But because CMS is unlikely to abandon its coding system, the best suppliers can hope for is a "merger" between the NCART and CMS methodologies, Walker figures.

"We prefer our codes," Hildebrandt agrees. But NCART will be pushing for CMS to collaborate with it and the industry at large to come to a "common agreement" on the final codes.

The coding proposals' highly technical nature may keep suppliers from commenting on them, experts fear. And lack of input from suppliers could pave [...]