SADMERC Medical Director: Power Chair Coding Is Job One

ATLANTA–Dr. Doran Edwards hopes the third time’s the charm for
Medicare’s new power mobility codes.

Less than a week after CMS announced it would delay
implementation of the codes–originally issued in February and
revised in mid-September–the SADMERC medical director announced
that he will now devote his full attention to reworking the codes
once more and will lead an advisory panel to do so.

“I have suspended all of my other SADMERC duties for this one
project. Whatever it takes, I’m willing to put in the time to do,”
he said Wednesday at a Medtrade session presented by the National
Coalition for Assistive and Rehab Technology.

“This is the third formal attempt to come to a consensus that
you agree with, CMS agrees with and the DMERCs agree with,” Edwards
told the audience. “This will impact the future of power mobility.
We must get this right.”

On Oct. 14, CMS announced it would delay implementation of the
codes, which had been scheduled to take effect Jan. 1, 2006 (see
HomeCare Monday, Oct. 17). Just a month earlier, the agency added
13 codes to the 49 it had issued in February and modified testing
requirements.

But speaking again at an early-morning Thursday session
sponsored by Sunrise Medical, Edwards explained that CMS recognized
additional codes were needed to accommodate lightweight travel
vehicles, which had not been recognized in the first round of codes
in February; hence the addition of more codes last month. Beyond
that, he said, there were also concerns with some safety issues
surrounding the codes, and that testing labs might not be
consistent in the way they performed tests for the new codes.

To remedy the situation, Edwards said CMS will empanel a
12-member technical committee to give input on the codes. The
agency is quickly soliciting participants for the group, which he
hopes will include manufacturers, providers, engineers, technicians
and clinicians–“all of those who have stakeholder status with
respect to power wheelchairs,” Edwards said. Medicaid has also
expressed an interest in participating on the panel, Edwards told
HomeCare Monday.

With an as-yet-unnamed CMS contractor as facilitator, the panel
will be seated within the next 30 days, he said, although details
about when and where it will meet have not yet been decided.

Nominees for panel seats should have “broad experience, and
perhaps [have] worked with more than one company or over a large
segment of the population. If it’s a clinician … I want someone
who’s not fresh out of school but has several years in the trenches
dealing with this, who is familiar with Medicare, familiar with
coding and has some grasp of the history of what’s going on … and
also has a very good grasp on what the range of the population to
be served by these chairs might be,” said Edwards, who will work
with CMS to select panel members.

While “the best of the best will be chosen to be on this
committee,” Edwards said, he will consider all nominees as “a
talent pool” from which the panel may draw for particular expertise
on specific questions.

With the second round of codes, Edwards explained, the emphasis
was on performance and durability, but clinical functionality was a
missing piece. “This is where we need people with broad-based
experience to [tell us] ‘What does this chair serve? Who are we
targeting for this?’” he said.

He continued that determining categories of chairs, not specific
codes, will be the initial matter at hand for the panel. “The first
question that will be tackled is, ‘Do we now have an adequate
breakout of categories of chairs? … What are your performance
levels? What are your durability levels? What are your
functionality levels? And how does that apply to a clinical
application?’ Once that is defined,” Edwards said, “then we can
worry about the codes … they’re nuts-and-bolts details.”

Pressure to ‘Get This Mess Straightened Out’ While the advisory
panel has an “undefined length of time to complete this revision,”
Edwards cautioned, “it’s not an indefinite time.

“There is still a great deal of pressure from Congress, from
Medicare, from Medicaid, from all the third-party payers to get
this mess straightened out … it’s got to be fixed.”

Thus, Edwards said, “We need people who can dedicate their lives
over the next three or four months to nothing but solving this
problem.”

He pointed out that since “HIPAA has required a universal code
set for all third-party payers, we may be creating codes that will
be invalid for Medicare … but perfectly valid for Medicaid or
private insurers. This is going to have a very broad-reaching and
thus long-term effect.

“Our goal is to get to the heart of the matter and settle this
once and for all so that the codes can remain in effect for a
number of years without having to be tweaked.” That means, Edwards
continued, “your lives are going to depend on what we do in the
next few months … so that’s why we want your input.”

But, Edwards emphasized, “If we pull this off successfully, it
may be the template for how all standards are applied to DME in the
future for competitive bidding. This is as open and transparent a
mechanism as I have ever seen from CMS.”

Edwards encouraged all of those interested in participating on
the panel to contact CMS by e-mailing Joel Kaiser,
[email protected], or Carol Blackford,
[email protected].