To Build or Not to Build: That Is the Manual Wheelchair Coding Question

ORLANDO, Fla.–It could be as late as January 2009 before new
codes for manual wheelchairs are implemented because officials are
still grappling with how they should be designed, according to a
top SADMERC official.

CMS and the SADMERC are attempting to revise the manual
wheelchair codes to keep up with new technology.

“The codes will define a continuum of technology that
increasingly provides more sizes, options and features that meet a
patient’s needs,” said Dr. Doran Edwards, the SADMERC’s medical
director, speaking at the National Coalition for Assistive and
Rehab Technology’s manual wheelchair update at Medtrade earlier
this month.

But the SADMERC is in a quandary about how best to do that, he
said. Officials are mulling two types of coding possibilities:

1. 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
2. Creating 40 codes in 10 weight categories to cover a spectrum
   of needs.

With the builder code, a provider would start with a basic
frame, seat back and wheels. Everything else would need to be
added. However, Edwards said, that could “make it possible for you
to make a chair more individualized.”

The weight-type coding would include more features, but there
could be a major drawback. “By doing that, we have handicapped
people who need one thing more and we’ve overpaid for those who
need less,” Edwards said.

It’s quite a challenge to decide which type of code serves both
the needs of the patients and the industry, Edwards said. “We’re
trying to create a coding platform that still allows for the
sophisticated products. So do we follow the model of the [power
mobility devices] and slice the pie as thinly as you can slice it?”
he asked, referring to the recently revised PMD codes that swelled
to a total of 78.

That might be too confusing, he said, “so maybe the builder
chair would be easier to deal with.”

Edwards said that various entities have already weighed in on
the issue, including manufacturers, clinicians, consultants and
professional organizations such as the Rehabilitation Engineering
and Assistive Technology Society of North America.

He would also like input from providers, he said, noting he
hopes that a decision regarding the codes will be made “somewhere
around the first of the year.”

The medical director also said the SADMERC is looking into
coding for pediatric chairs. As many as a dozen codes could be
added in that category, he said.

Whatever the SADMERC finally decides, things will not be the
same. Coding changes will lead to reimbursement changes. Crash
testing might become a required option. Codes for various options
and accessories would also be revised.

“I live in an Alice in Wonderland world,” Edwards said. “We’re
in the mushroom stage. Whatever we do, it’s going to change.”

One thing will not change. “We still want to provide the full
technology to the patient,” he said.

Comments on the codes can be e-mailed to [email protected].