New Manual Wheelchair Codes in Limbo with SADMERC Transition

COLUMBIA, S.C.–In a move that could delay the long-awaited
manual wheelchair code set revision, the SADMERC will transition to
a new carrier next month.

Noridian Administrative Services will be the new Pricing, Data
Analysis and Coding Contractor–or PDAC–taking over the duties of
Palmetto GBA, the Statistical Analysis DME Regional Carrier,
effective Aug. 18. CMS announced the change last week.

Under the contract, the PDAC will be responsible for:
–Providing data analysis support to the DME Program Safety
Contractors;
–Guiding manufacturers and suppliers on the proper use of HCPCS
codes for Medicare billing purposes through product reviews and
decisions, the DME coding system and the HCPCS Helpline;
–Conducting national pricing functions for DMEPOS services;
and
–Assisting CMS with DMEPOS fee schedules.

It also is charged with continuing the SADMERC’s effort to
create a new reimbursement code for manual wheelchairs.

“The manual wheelchair code set revision effort will be
transitioned to the new PDAC, along with all the other tasks
performed by the SADMERC,” confirmed Doran Edwards, M.D.,
SADMERC medical director. “The new team will be in contact
with CMS and will most likely review the current status of the
effort and decide whether to start with the current template or
begin again.”

Edwards said whatever the PDAC decides to do, it is unlikely
that the revised code set could be implemented in January 2009 as
was hoped.

“The transition may make a January 2009 implementation
date difficult to achieve for a new manual wheelchair code
set,” Edwards said. “Release dates after that are more
likely depending on how much of the current work is accepted as is
and how much is redone.”

He added, “So much work has gone into the task to date
that I believe the current template will continue to be used, and
only additional fine-tuning will be needed.”

The SADMERC, in order to better reflect changing technology, has
been working on the manual wheelchair coding revision for several
years. The sticking point has centered around which type of code
best serves both the needs of patients and the industry.

At Medtrade 2007 in Orlando, Edwards said the revision team was
considering two types of codes: establishing 10
“builder” codes that would allow a variety of options
so a manual wheelchair could be customized for a patient’s weight
and health requirements; or creating 40 codes in 10 weight
categories to cover a spectrum of needs.

“Work has continued on both pathways to study the impact
to suppliers and manufacturers,” Edwards said last week.
“The current suggested coding structure is a combination of
the two pathways and would include some of the best features of
both. The final decision on which way to go will be made by CMS and
the new carrier after the transition.”

Edwards said he hoped to be part of that decision. “I
would like to continue to work with the new team following
transition so major projects can be continued with little
interruption, but no decision on my continuing involvement with the
new carrier has been made.”

In any case, the new code set will likely reflect the input from
the industry that the SADMERC had requested.

“As always, the industry responded very well to the
SADMERC’s request for assistance,” Edwards said, adding that
the majority of the comments received favored builder codes over
defined codes. “We received many good comments and helpful
suggestions. We also learned of niche products that were not fully
described by current coding, and we have attempted to include them
this time.”

For transition updates and further information, check the
SADMERC Web site, www.palmettogba.com, until the PDAC Web
site–www.dmepdac.com–is launched. No launch date has yet been
announced.

The SADMERC also announced that the HCPCS Helpline would not be
available from 11 a.m. CT Aug. 15 to 8:30 a.m. CT Aug. 18.