Editor's Note

Honor Code

• By Laurie Watanabe
• May 01, 2016

On my way back from March’s International Seating Symposium in Vancouver, B.C., I ran into a clinician at the airport. I don’t recall exactly how we got onto the subject of HCPCS codes — isn’t that what everyone talks about in airport terminals? — but she recalled that a client’s mobility system went literally overnight from perfect to pariah when the power wheelchair was reclassified from a Group 3 to a Group 4.

“The same wheelchair she’d used for years,” the clinician said of her client’s system. “It worked great for her. We had everything dialed in. And then one day her wheelchair went from being a great solution to no longer being funded. Just like that. She didn’t change, her needs didn’t change. Her condition didn’t change, the chair didn’t change. Just its code did.”

That sounds like a perfect example of when HCPCS codes become the tail wagging the dog. I think everyone agrees that with tens of thousands of products and components in complex rehab, maybe hundreds of thousands in durable medical equipment as a whole, there needs to be a way to organize them and streamline the medical justification and payment process. But HCPCS codes should be tools that help us to get things done, not the wrenches in the works.

In the case this clinician mentioned, her client was a long-time user who knew exactly what she wanted, and in previous years, after confirming everything in the evaluation, the seating & mobility team “re-ordered” her seating and wheelchair when replacement time came around. But suddenly, the system that had worked for years was no longer available. One day, the chair had a Group 3 code, and everything was fine. The next day, it was reclassified as a non-funded Group 4 chair, and the seating team had to scramble for a suitable replacement. Surely, the replacement system felt second best to the client who’d gotten used to driving and operating the same wheelchair for many years.

In this issue, we tackle another coding conundrum: the K0108 miscellaneous HCPCS code for complex rehab technology (CRT). This catch-all code covers an incredible range of products that have one thing (besides the CRT tag) in common: They don’t have narrower, more distinct codes of their own. And because they’re often handled rather arbitrarily by funding sources, K0108 products can be very challenging to ATPs and funding specialists. So we gathered our own group of reimbursement and coding experts and asked them to share their experiences, advice and best practices when dealing with this crucial code.

We’ll also check on the status of that 2015 declaration by the Centers for Medicare & Medicaid Services (CMS) that the agency would eliminate the K0108 code and replace it with multiple new codes based on pricing…a decision that CMS walked back last fall without much explanation, just a few months before the new policy was to start.

There was no perfect solution for that client whose power chair suddenly became unobtainable, and codes and their accompanying allowables continue to be more whimsical than anyone in CRT would like. So we know our cover story won’t entirely fix the unpredictability of K0108 reimbursement, but we do hope to leave you with a little better understanding of it, and maybe with a few tips you can start applying today to lessen the worst of the sting.

This article originally appeared in the May 2016 issue of Mobility Management.