Funding Essentials

Power Mobility Device Options: Coding Q&A

On Sept. 22, Jim Stephenson presented a Mobility Management Webinar called Smart Billing: Power Mobility Device Options & Accessories. Afterward, Jim fielded live questions from Webinar attendees on topics ranging from HCPCS codes to repairs.

Register to hear the on-demand archive of the full Webinar and watch for future MM Webinars on a range of seating & mobility topics at mobilitymgmt.com. — Ed.

Q: I use E1028 for all mounting hardware. Reimbursement is $186.79 or manufacturer’s suggested retail price (MSRP) if charges are greater. I have not been denied. Should I be using K0108, or is either way correct?

A: E1028 is only used for swingaway, retractable or removable hardware for a joystick, other drive control interface or a positioning accessory. Most fixed hardware is included in the base code for the item that is being attached; therefore, there is no additional coding or reimbursement in these situations. If you are replacing fixed hardware, then K0108 is the appropriate code to use for billing purposes.

Q: Would it be acceptable to use E1028 to bill for tray-attaching hardware in cases where the tray is used to mount an alternative drive control (i.e., switches)? We understand that otherwise the tray would not be covered.

A: As long as the hardware is being used for a remote joystick, touchpad, head control interface (E2327-E2330) or an indicator display box that is related to the multi-motor electronic connection (E2310 or E2311), E1028 would be covered. In the case of a switch driver, a case could be made for an exception to the specific language in this rule.

Q: When doing a custom-molded seat and back on a new power wheelchair, can we bill labor code K0739?

A: When providing a new custom-molded seat and/or back, labor, setup and delivery are all included in the allowance for the base code, E2609 or E2617.

Q: What allowable do we use for a Group 4 power wheelchair? What do we put on the detailed product description for the allowable when doing an ADMC (Advance Determination of Medicare Coverage) request?

A: A Group 4 wheelchair has to be provided as an upgrade, so the allowable you use is based on the equipment for which the patient actually qualifies. For example, if you provide a K0884 and the patient qualifies for Group 3, you would use the allowable for a K0861.

Q: Can a physiatrist (rehab doctor) do the evaluation for a power chair with power tilt/recline, or does the patient also need to have a PT/OT evaluation?

A: The specialty exam must be performed by a licensed/certified medical professional, such as a physical or occupational therapist, or physician who has specific training and experience in rehabilitation wheelchair evaluations. The person performing this exam may, but is not required to be, a RESNA-certified ATP.

Q: Do parts being replaced require the KX modifier?

A: Parts do not require the KX modifier. You should use the NU RB modifiers for replacement parts that are necessary to repair the base equipment.

Q: Why is the power articulating foot platform — coded K0108 — only being paid at around $1,034 (which is the fee schedule for power elevating legrests) and not at 80 percent of the MSRP of the platform, which is about $2,895?

A: Even though Medicare Pricing, Data Analysis & Coding (PDAC) has officially coded most of the power articulating foot platforms on the market as K0108, Medicare has made the determination that those products provide the same functionality as individual power elevating legrests. Therefore, Medicare only pays an amount equal to the E1010 allowable.

Q: We have been getting denials on K0040 for E1161 chairs. What justification do we need to document?

A: Here are some examples of possible justifications for adjustable-angle footplates:

  • The patient has a plantar flexion, dorsiflexion or an inversion/eversion contracture.
  • The patient has hamstring tightness or a knee contracture that needs to be accommodated, making a standard 60° or 70° footrest become a tighter or more open angle.
  • The patient wears ankle-foot orthoses (AFO) and needs the footrest to accommodate to a set angle.
  • Adjustable-angle footplates are needed to decrease the tone that can lead to thrusting from the chair.

Q: Does documentation for time of repairs need to be submitted with the claim or just kept on file?

A: Documentation for repairs does not need to be submitted with the claim, but kept on file and provided upon request.

Q: Can you explain the difference between the RB modifier and the RA modifier?

A: The RB modifier is used on replacement parts that are necessary to repair a wheelchair. The RA modifier is used when the entire wheelchair is being replaced.

This article originally appeared in the November 2011 issue of Mobility Management.

About the Author

Jim Stephenson is Reimbursement & Coding Manager for the Rehab Department of Invacare Corp.

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