Coping with Cushions

If the wheelchair accessory code changes earlier this year weren’t enough, CMS also introduced new wheelchair cushion codes that became effective in July. To avoid increased DSO (days sales outstanding), denials and other headaches, it is vital for providers to keep up with these changes.

If you have any questions about cushion codes, call the SADMERC to verify the HCPCS code for the cushion that has been prescribed for your patient, because a “cross-walk” has not been furnished from the old codes to the new codes. I suggest you keep a SADMERC logbook documenting the make, model, manufacturer, serial number or model number, the person you spoke with, and the time and date. Because these codes are so important, you should refer to the SADMERC about the new codes.

The two most used wheelchair cushions have always been the E0178 and the E0192. Now, there are many new “K” codes for wheelchair cushions. Providers should verify what they have in inventory, and then assign an employee to call and verify the proper HCPCS codes for those cushions. Billing the old codes will simply result in a denial. Remember that a “KX” modifier is required on wheelchair cushions stating to Medicare that you have the documentation as required by policy in the patient’s file.

The original determination effective date was July 1, and the final effective date was Oct. 1. Log on to your DMERC Web site, and click on the medical policies section to view the information they have posted on wheelchair seating. Print the entire new policy, have your employees read it thoroughly, and pull down the new fee schedule as well. Make sure your staff understands the new rules.

The basic coverage guidelines below may assist you in understanding this complicated policy.

1. Covered if patient meets criteria for a wheelchair:
   • K0650, K0651 — general use seat cushion
   • K0060, K0061 — general use back cushion
   • The “skin protection” seat cushions (K0652, K0653) are covered if:
   • The patient qualifies for a wheelchair
   • The patient has either of the following:
   • The positioning seat cushion (K0654, K0655), positioning back cushion (K0662 – K0665) and positioning accessory (E0955-E0957, E0960) is covered for patients who meet both of the following:
     • Patient meets criteria for and has a wheelchair; and
     • The patient has any significant postural asymmetries caused by one of the diagnoses above or to any of the following ICD-9 codes: 344.30-344.32, 438.40-438.42, 342.00-342.92, 438.20-438.22, 359.0, 359.1, 333.4, 333.6, 333.7), 334.0-334.9.
     • For HCPCS codes K0656, K0657, combination skin protection and positioning seat cushions are covered for patients who meet the criteria for both a skin-protection and positioning seat cushion.

Be certain you have a Written Order Prior to Delivery (WOPD) in your hand before delivering any of these cushions to your patients. If you do not obtain a WOPD, the item will require an “EY” modifier, and you will not be reimbursed.

And remember, there are more changes coming as CMS has said it plans to bundle wheelchair billing with the most common accessories into a collection of new codes next year. Then it will be even more important for providers to stay educated on and aware of any coding changes, and to make certain that everything they deliver is billed appropriately.

Jane Bunch is CEO of Kennesaw, Ga.-based JB&CS. A reimbursement specialist, Bunch delivers educational seminars worldwide, helps develop corporate compliance plans, and serves as a consultant for fraud and abuse cases. She can be reached at 678/445-1221 or via e-mail at [email protected].