Downsize Those DSOs

HCPCS Code K0006
(heavy-duty wheelchair base)

Average Medicare DSO
64 days

When billing for the K0006, it is important to have copies of the patient’s medical records documenting medical necessity in your chart. Those records need to include proof that the patient is unable to complete mobility-related activities of daily living in the home, an explanation of why a lower level of wheelchair base cannot be used and the patient’s exact weight or spasticity specifics.

In order to qualify for the heavy-duty wheelchair base, the patient must weigh more than 250 pounds or suffer from severe spasticity — tight or stiff muscles resulting from a disorder or injury to the nervous system (cerebral palsy, brain injury, stroke, spinal cord injury or multiple sclerosis) that make movement, especially of the arms and legs, difficult or uncontrollable.

The provider should request copies of the patient’s records from the physician, hospital, skilled nursing facility, physical therapist, occupational therapist and other health care providers prior to submitting the claim. By obtaining the information from the charts of the other health care providers involved in the patient’s treatment, you have the assurance that the patient meets the criteria for the K0006 and that you meet the intent of CMS’ mobility assistive equipment policy.

Sarah Hanna is a reimbursement consultant and vice president of ECS Billing & Consulting, Tiffin, Ohio, and specializes in proper billing protocols, Medicare coverage guidelines and billing office procedures. She can be contacted at 419/448-5332 or [email protected].

Data represents a categorized and weighted analysis of approximately 716,230 Medicare paid claim lines adjudicated by the four DMERCs between June 1, 2006, and June 30, 2006, and processed for RemitDATA customers. Figures reflect the average number of days elapsed from date of service to Medicare check issue date. Source: RemitDATA, 866/885-2974, www.remitdata.com