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:
- 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.
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 dr.doran.edwards@palmettogba.com.