Home Health & Hospice Week

Include physicians and therapists in your education efforts.

Reminding physicians of how they can make extra money on wheelchair patients could help boost your referrals.

Docs shouldn't miss out on an extra $21.60 of reimbursement per wheelchair patient. As of April 1, they can bill and receive payment for G0372, the new code for physician oversight of power mobility devices (PMDs) such as wheelchairs and scooters.

Congress had delayed the start of Medicare's new PMD coverage rule until April to allow for more comments from suppliers and physicians.

Slow start: But many physicians still haven't realized they can reap extra reimbursement just for filling out a little extra paperwork, says Kimberly Haspert, operations manager with New Pueblo Medicine in Tucson, AZ. "My biggest challenge is always educating and reminding providers about new billable services and how to document them properly," she adds.

Also, docs will have 45 days instead of 30 days to send medical-necessity documentation to durable medical equipment suppliers after seeing a patient face to face. The Centers for Medicare & Medicaid Services extended the time frame after physicians said a 30-day window was too narrow, according to the final regulation published in the April 5 Federal Register (see Eli's HCW, Vol. XV, No. 15).

Reminder: You can also tell referral sources the final regulation does away with the Certificate of Medical Necessity (CMN) they've been using to justify wheelchair prescriptions. And it requires physicians to see the patient face-to-face before prescribing a new PMD.

Important: Physicians must bill for an E/M visit on the same claim as G0372, CMS says in a recent MLN Matters article (MM4372).

Remind physicians their patient charts should contain certain medical necessity information, Tammy Boyer, compliance and billing officer with Great River Orthopaedic Surgery in West Burlington, IA says. That includes:

• Has the patient tried other manual wheelchairs previously?

• Is the patient going to use this PMD for "outside motion" only, or indoors as well?

• Does the patient have enough functioning of the upper extremities to operate a manual wheelchair?

So far, only Medicare appears ready to pay for G0372, says Boyer, who's contacted some other payors about the code.

No Code For Therapists

The PMD final rule notes that "prescribing physicians or treating practitioners who submit the required supporting documentation may submit a claim for payment for the add-on G code."

But therapists don't qualify as those other "treating practitioners." Only physicians, physician assistants, nurse practitioners and clinical nurse specialists may use this code, since they're defined by the Social Security Act as the types of practitioners who can prescribe power mobility devices (PMDs), explains physical therapist Barbara Levy, supervisor of the seating and mobility clinic for Thoms Rehabilitation Hospital in Asheville, NC.

The good news: The final rule does, however, recognize that physical and occupational therapists have an important role in the prescription process and that they may be reimbursed for their evaluation time. "A PT/OT can file a claim for payment for their evaluation services, provided that all other applicable payment conditions are met," CMS says in the comments section of the final rule.

You can tell therapists who are involved in fitting a patient for a PMD that they can use 97001 (Physical therapy evaluation), 97003 (Occupational therapy evaluation) or 97542 (Wheelchair management [eg assessment, fitting, training], each 15 minutes), Levy says.

If you're wondering how therapists and physician can work together on wheelchairs, look at this example. "We ... evaluate the referred patients and provide detailed assessments and documentation on why we recommend certain equipment," says Matthew Lewis, rehab manager for the adaptive seating clinic at Forsyth Medical Center in Winston-Salem, NC.

"We complete a detailed letter of necessity, and our vendors will often ask our prescribing physician to co-sign the letter. And even after the physician's face-to-face exam, he still counts on the letter we write and attaches it to his documentation," Lewis adds.

Act now: The final rule just took effect June 5, so now's a good time to communicate with referring physicians and therapists about the rule's changes.