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.