Manuals: Coding decisions cause complications

ATLANTA - Two recent coding decisions by the PDAC that involve manual wheelchairs are putting patient access at risk, says Rita Hostak, vice president of government relations for Sunrise Medical.

“These decisions are not benign,” she said during a complex rehab update at Medtrade Oct. 18. “They have a very significant impact on the industry and the people who need this equipment.”

The more troubling of the two coding decisions: K0009, a miscellaneous custom ultralight wheelchair, will soon be categorized under the manual wheelchair HCPC code. Manufacturers have until March to resubmit K0009 coding verification applications to the PDAC while the contractor works to revise the code.

“They don't like miscellaneous codes,” said Hostak. “Their intention is to move this into the existing (manual wheelchair) HCPC code.”

This will create access problems because K0009 would become a capped-rental item and providers would have no way to bill for the wheelchair's tilt feature. Also, it would clear the way for K0009 to be included in competitive bidding, Hostak said.

“I don't know that they understand the potential impact,” she said.

The other coding decision putting patients in jeopardy: A requirement announced this summer that E1161 manual wheelchairs be provided with wheels large enough and positioned to self-propel. Users in these wheelchairs generally don't self-propel and the decision about whether the wheelchairs should have larger wheels should be made on an individual basis , Hostak said.

“They're confused about the population that uses this chair,” she said. “There are reasons why you wouldn't choose those wheels for these patients, like safety. We want to keep people's hands out of the way.”

NCART has reached out to the PDAC and the medical directors to let them know the consequences of these decisions. It believes the PDAC should consult manufacturers and providers about potential impacts before making coding decisions like these, says Don Clayback, executive director.

"The consequences can be significant," he said. "And decisions like these trickle down to other payers."