I attended the Nov. 30 Centers for Medicare & Medicaid Services (CMS) second biannual HCPCS Coding Cycle public meeting for the discussion about coding and reimbursement for power seat elevation.
That part of the meeting lasted nearly two hours.
Here’s my takeaway: The unique nature of Complex Rehab Technology (CRT) is still not wholly understood outside the industry.
How Unique Is Unique?
To a certain point, I understand. Unique is often diluted to mean “unusual,” rather than “the only one; without a like or equal,” as Merriam-Webster says.
We hear the phrases “more unique” or “very unique,” when the true meaning of the word is “one of a kind.” And there’s no real harm done if I say that double rainbows or snow flurries in my Southern California hometown are “unique.”
But in CRT, unique must retain its full strength and accuracy. Because when we say a seating client is one of a kind, we mean it.
NCART says CRT products “include medically necessary, individually configured devices that require evaluation, configuration, fitting, adjustment or programming. These products and services are designed to meet the specific and unique medical, physical, and functional needs of an individual with a primary diagnosis resulting from a congenital disorder, progressive or degenerative neuromuscular disease, or from certain types of injury or trauma.”
The seat elevation meeting on Nov. 30 was a case of what can happen when unique isn’t understood.
The Asymmetry of CRT Seating
CMS representatives questioned industry presenters Julie Piriano, PT, ATP/SMS, Quantum Rehab; Bill Ammer, Ammer Consulting; Brad Peterson, Amylior; and Peter Thomas, ITEM Coalition/Powers Pyles Sutter & Verville.
Piriano, Ammer, Peterson, and Thomas advocated for a separate HCPCS code for heavy-duty seat elevation, one that would distinguish it from standard seat elevation. Heavy-duty seating system components do need to be more robust to handle higher body weights. And those more robust materials and construction are more costly than what’s used to build standard power chairs.
But industry speakers also noted that seating clients with higher body weights are not identical. In addition to having different diagnoses and presentations, they also carry their weight differently.
In my early years covering the CRT industry, Brad Peterson was among those seating experts who taught me about lymphedema and how it affects center of gravity.
Let’s say we have two seating clients, each weighing 500 lbs. The first client carries the weight symmetrically, with the amount of weight below the waist and above the waist being roughly equal. Laterally, the weight of the left side of the body is similar to the weight on the right side of the body.
But the second client has lower-extremity lymphedema, with a very large percentage of body weight below the waist.
Those two power wheelchairs will have different centers of gravity.
Those two clients will also move differently. Do their transfers differently. Reach differently. Weight shift differently. All of which will impact the center of gravity and seating stability repeatedly throughout the day.
Unique Clients in Unique Situations
Each CRT power wheelchair is custom fit and configured for one client. Just because two clients weigh the same amount doesn’t mean they would use the same seating system on the same power chair. We also know clients have their own medical histories, diagnoses, prognoses, goals, environments, and functional capabilities.
Failing to understand each client’s truly unique situation puts access to complex seating at risk. It puts client safety at risk. It endangers the sort of active, involved lifestyle you work so hard to achieve for your clients.
Many people may think that aside from sunsets and fingerprints, uniqueness is rare in the world. But If you work in CRT, uniqueness is as close as your seating clinic.
The challenge is teaching that fact to everyone else.
Image: istockphoto/Svetlana Zaytseva
