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Medicare Compliance & Reimbursement

CODING:

A Closer Look--How To Properly Document Wheelchair Medical Necessity

Published on Sat Apr 01, 2006

Hint:  G0372 must be on the same claim as E/M code.

Providers: Don't miss out on an extra $21.60 of reimbursement per wheelchair patient.

As of April 1, providers can bill and receive payment for G0372, the new code for physician oversight of power mobility devices, such as wheelchairs and scooters. Congress had delayed the start of Medicare's new PMD coverage rule until now to allow for more comments from suppliers and physicians.

But many providers still haven't realized that 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.

Also, providers have 45 days instead of 30 days to send medical-necessity documentation to durable medical equipment suppliers after the physician sees a patient face to face. The Centers for Medicare & Medicaid Services extended the timeframe after physicians said a 30-day window was too narrow, according to the final regulation, published in the April 5 Federal Register (see "PMD Suppliers Say 'Proceed With Caution' Under Final Rule" included in this issue).
 
Providers must bill for an E/M visit on the same claim as G0372, CMS says in a new Medlearn Matters article (MM4372).

The DME supplier can provide the physician with a two-page form to fill out which can help prove the medical necessity for the wheelchair or scooter, says Tammy Boyer, compliance and billing officer with Great River Orthopaedic Surgery in West Burlington, IA. But the patient's chart should also contain medical necessity information, such as:

· Has the patient tried other manual wheelchairs before?
· 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?

As long as the physician is "trained" as to the medical necessity criteria for a PMD, there should be no problem, says Boyer. But if the physician isn't up on the requirements, he or she may leave out important information "and create chaos."

So far, only Medicare will pay for G0372, says Boyer, who's contacted some other payers about the code.

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