REF EDU/0107-37, Rev. B (1HR)
PMD Documentation Requirements
Made EASY for Clinicians
Clinical Development & Technical Education
www.prideprovider.com
www.quantumclinician.com
800-800-8586
REF EDU/0107-37, Rev. B (1HR)
Learning Objectives
 The participants will review Medicare’s PMD policy and coverage
criteria to ensure they have and understand the most current accurate
information.
 The participants will identify how to obtain and verify that all
documentation requirements have been met.
 The participants will learn the most critical information for PMD funding
and how to ensure it is clearly written in the wheelchair evaluation.
REF EDU/0107-37, Rev. B (1HR)
Satisfactory Completion Requirements
As a learner….
1)
2)
3)
4)
Sign-in.
100% Attendance requirement
Sign out
Sign-out
Required to complete an evaluation form on the day of the
event.
 Failure to abide by any of these will result in no credit.
 A learner must sign-in, sign-out, and complete an evaluation form
to get a Certification of Completion.
 If one item is missing, it will be treated as if the learner was never
in attendance.
No partial credit will be awarded.
REF EDU/0107-37, Rev. B (1HR)
Balance
Was the Detailed Product Description signed?
Were all least costly alternatives
ruled out?
I know the patient qualifies!
The patient needs it!
Is the 7 Element Order valid?
Did we do a home
assessment?
Did we get the
attestation with LCMP?
Chart note? Why
can’t we use a form?
We will lose the sale!
It is obvious!
Is the Face to Face Exam a chart note?
Did physician cosign LCMP evaluation?
Did I date stamp everything?
REF EDU/0107-37, Rev. B (1HR)
PMD Coverage Criteria
REF EDU/0107-37, Rev. B (1HR)
National Coverage Determination for
Mobility Assistive Equipment
• Effective Date
– 5/5/2005
• Implementation Date
– 7/5/2005
• “Mobility assistive equipment” (MAE) includes, but is not limited to,
canes, crutches, walkers, manual wheelchairs, power wheelchairs,
and scooters
• Determination of a mobility deficit will be made by an algorithmic
process
REF EDU/0107-37, Rev. B (1HR)
MAE Coverage Criteria (Algorithm)
REF EDU/0107-37, Rev. B (1HR)
National Coverage Determination for
Mobility Assistive Equipment
• MAE is reasonable and necessary for beneficiaries who have a
personal mobility deficit sufficient to impair their participation in
mobility-related activities of daily living (MRADLs) such as
– toileting,
– feeding,
– dressing,
– grooming, and
– bathing
• in the customary locations within the home
REF EDU/0107-37, Rev. B (1HR)
National Coverage Determination for
Mobility Assistive Equipment
• Does the beneficiary have a mobility limitation that
significantly impairs his/her ability to participate in
one or more MRADLs in the home?
• A mobility limitation is one that:
– Prevents the beneficiary from accomplishing the MRADLs entirely
= (Independently)
– Places the beneficiary at reasonably determined heightened risk of
morbidity or mortality secondary to the attempts to participate in
MRADLs = (Safely)
– Prevents the beneficiary from completing the MRADLs within a
reasonable time frame = (Timely)
REF EDU/0107-37, Rev. B (1HR)
National Coverage Determination for
Mobility Assistive Equipment
• Can the functional mobility deficit be sufficiently
resolved by the prescription of a cane or walker?
– The cane or walker should be appropriately fitted to the
beneficiary for this evaluation
– Assess the beneficiary’s ability to safely use a cane or
walker
Tried and failed ……..(safety or reasonable
time frame)
Considered and ruled out ……(safety or
reasonable time frame)
REF EDU/0107-37, Rev. B (1HR)
National Coverage Determination for
Mobility Assistive Equipment
• Does the beneficiary have sufficient upper extremity
function to propel a manual wheelchair in the home to
participate in MRADLs during a typical day?
• The manual wheelchair should be optimally configured
(seating options, wheelbase, device weight, and other
appropriate accessories) for this determination.
– Limitations of strength, endurance, range of motion,
coordination and absence or deformity in one or both
coordination,
upper extremities are relevant.
REF EDU/0107-37, Rev. B (1HR)
National Coverage Determination for
Mobility Assistive Equipment
– A beneficiary with sufficient upper extremity function
may qualify for a manual wheelchair
wheelchair. The appropriate
type of manual wheelchair, i.e. light weight, etc., should
be determined based on the beneficiary’s physical
characteristics and anticipated intensity of use.
– The beneficiary's home should provide adequate
access, maneuvering space and surfaces for the
operation of a manual wheelchair
wheelchair.
– Assess the beneficiary’s ability to safely use a manual
wheelchair.
REF EDU/0107-37, Rev. B (1HR)
PMD Documentation Requirements
Quantitative Measurements (must be provided when applicable)
 Muscle Strength Grading
5/5 - Full range of motion, full resistance
4/5 - Full range of motion, some resistance
3/5 - Full range of motion with gravity
2/5 - Full range of motion without gravity
1/5 - Slight contraction, no movement
0/5 - No contraction
 Range of Motion
 Oxygen Saturation
Pt. On 4 liters with a SAT of X% with minimal exertion drops to X%
REF EDU/0107-37, Rev. B (1HR)
Coverage Criteria
A standard manual wheelchair (K0001) is covered if:
The patient has a mobility limitation that significantly impairs his/her ability to
participate in one or more mobility related activities of daily living (MRADLs)
such as toileting, feeding, dressing, grooming, and bathing in customary
locations in the home.
AND
The patient’s mobility limitation cannot be sufficiently resolved by the use of
an appropriately fitted cane or walker.
Covered for an individual who is unable to ambulate safely, timely or
independently. Typically for short-term use.
REF EDU/0107-37, Rev. B (1HR)
Coverage Criteria
A standard hemi-wheelchair (K0002) is covered when the patient meets the
coverage criteria for a standard manual wheelchair and requires a lower seat
height (17” to 18”) because of short stature or to enable the patient to place
hi /h feet
his/her
f t on the
th ground
d ffor propulsion.
l i
A lightweight wheelchair (K0003) is covered when a patient meets the
coverage criteria for a standard manual wheelchair and:
cannot self propel in a standard wheelchair in the home; and
the patient can and does self-propel in a lightweight wheelchair.
REF EDU/0107-37, Rev. B (1HR)
Coverage Criteria
A high strength, lightweight wheelchair (K0004) is covered for a patient who
meets the coverage criteria for a:
 Standard manual wheelchair (K0001) and:
(rule out cane and walker)
 Self propels the wheelchair while engaging in frequent activities in the home that
cannot be performed in a standard or lightweight wheelchair, and/or
(rule out K0001 and K0003)
 Requires a seat width, depth, or height that cannot be accommodated in a
standard, lightweight, or hemi-wheelchair, and
 Spends at least two hours per day in the wheelchair
Note: A high strength lightweight wheelchair is rarely reasonable and necessary if
the expected duration of need is less than three months (e.g., post-operative
recovery).
Many K0004 W/Cs can be customized to meet the client’s condition (long term use)
REF EDU/0107-37, Rev. B (1HR)
Coverage Criteria
 Ultra lightweight wheelchairs (K0005) are eligible for Advance Determination
of Medicare Coverage (ADMC aka “Prior Authorization”)
Patient’s
diagnosis duration of condition and expected prognosis
 Patient
s diagnosis,
prognosis,
 Patient’s abilities and limitations as they relate to the equipment,
 A description of the patient’s routine activities, the types of activities the patient
frequently encounters
 A description of the features of the K0005 base which are needed compared to
the K0004 base
 Size and proper position of propulsion wheels (need for an adjustable rear axle)
REF EDU/0107-37, Rev. B (1HR)
K0005 Update
Effective March 1, 2013
For MEDICARE - An ultra lightweight manual wheelchair (K0005) is covered
for a beneficiary if criteria (1) or (2) is met and (3) & (4) are met:
1. The beneficiary must be a full-time manual wheelchair user.
2. The beneficiary must require individualized fitting and adjustments for one
or more features such as, but not limited to, axle configuration, wheel
camber, or seat and back angles, and which cannot be accommodated by a
K0001 through K0004 manual wheelchair.
3. The beneficiary must have a specialty evaluation that was performed by a
licensed/certified medical professional (LCMP), such as a PT or OT, or
physician
p
y
who has specific
p
training
g and experience
p
in rehabilitation
wheelchair evaluations and that documents the medical necessity for the
wheelchair and its special features (see Documentation Requirements
section). The LCMP may have no financial relationship with the supplier.
4. The wheelchair is provided by a Rehabilitative Technology Supplier (RTS)
that employs a RESNA-certified Assistive Technology Professional (ATP)
who specializes in wheelchairs and who has direct, in-person involvement in
the wheelchair selection for the patient.
REF EDU/0107-37, Rev. B (1HR)
National Coverage Determination for Mobility Assistive Equipment
• Does the beneficiary or caregiver demonstrate the
p
y and the willingness
g
to consistently
y operate
p
capability
the MAE safely?
• Safety considerations include personal risk to the beneficiary as well
as risk to others. The determination of safety may need to occur
several times during the process as the consideration focuses on a
specific device.
• A history of unsafe behavior in other venues may be considered.
• NOTE: If the beneficiary is unable to self-propel a manual wheelchair,
and if there is a caregiver who is available
available, willing
willing, and able to provide
assistance, a manual wheelchair may be appropriate.
REF EDU/0107-37, Rev. B (1HR)
National Coverage Determination for
Mobility Assistive Equipment
• Does the beneficiary have sufficient strength and
postural
t
l stability
t bilit tto operate
t a POV/
POV/scooter?
t ?
– A POV is a 3- or 4-wheeled device with tiller steering and limited
seat modification capabilities. The beneficiary must be able to
maintain stability and position for adequate operation.
– The beneficiary's home should provide adequate access,
maneuvering space and surfaces for the operation of a POV.
– Assess the beneficiary’s ability to safely use a POV/scooter.
REF EDU/0107-37, Rev. B (1HR)
Coverage Criteria
• A POV is covered if the patient is able to:
• Safely transfer to and from a POV, and
• Operate the tiller steering system
system, and
• Maintain postural stability and position while operating the POV in
the home.
• The patient's home provides adequate access between rooms,
maneuvering space, and surfaces for the operation of the POV that is
provided.
• Use of a POV will significantly improve the patient's ability to participate
in MRADLs and the patient will use it in the home
home.
REF EDU/0107-37, Rev. B (1HR)
Clinical Considerations
Scooters are good for people who…
• Have head/trunk control and can use their
arms/hands to steer/control the throttle
• Can get in and out of the seat safely
• Travel longer distances
• Can walk short distances
REF EDU/0107-37, Rev. B (1HR)
Clinical Considerations
• Scooters are not good when …
– Seating and/or positioning components are necessary or
f
there is a projected future
need
– Power seating functions are needed or may be required in
the future
– An alternative drive method is required or may be
necessary in the future
g radius limits mobility
y
– The turning
or independence
REF EDU/0107-37, Rev. B (1HR)
National Coverage Determination for
Mobility Assistive Equipment
• Are the additional features provided by a power
wheelchair needed to allow the beneficiary
y to p
participate
p
in one or more MRADLs?
• The pertinent features of a power wheelchair compared to a POV are
typically control by a joystick or alternative input device, lower seat
height for slide transfers, and the ability to accommodate a variety of
seating needs.
• The type of wheelchair and options provided should be appropriate
for the degree of the beneficiary’s functional impairments.
• The beneficiary
beneficiary'ss home should provide adequate access,
access
maneuvering space and surfaces for the operation of a power
wheelchair.
• Assess the beneficiary’s ability to safely use a power wheelchair.
REF EDU/0107-37, Rev. B (1HR)
Coverage Criteria
A Power Wheelchair (PWC) (K0813-K0891, K0898) is covered if:
•
All of the basic coverage criteria for a PMD (A-C) are met; and
•
The patient does not meet coverage criterion D, E or F for a POV; and
•
Either criterion J or K is met; and
•
Criteria L, M, N and O are met; and
•
Any coverage criteria pertaining to the specific wheelchair type are met.
REF EDU/0107-37, Rev. B (1HR)
Coverage Criteria
A Power Wheelchair (PWC) (K0813-K0891, K0898) is covered if:
J. The patient has the mental and physical capabilities to safely operate the power
wheelchair that is provided; or
K If the patient is unable to safely operate the power wheelchair
K.
wheelchair, the patient has a
caregiver who is unable to adequately propel an optimally configured manual
wheelchair, but is available, willing and able to safely operate the power
wheelchair that is provided; and
L. The patient’s weight is less than or equal to the weight capacity of the power
wheelchair that is provided and greater than or equal to 95% of the weight
capacity of the next lower weight class.
M. The p
patient’s home p
provides adequate
q
access between rooms,, maneuvering
g
space and surfaces for the operation of the power wheelchair that is provided.
N. Use of a power wheelchair will significantly improve the patient’s ability to
participate in MRADLs and the patient will use it in the home. For patients with
severe cognitive and/or physical impairments, participation in MRADLs may
require the assistance of a caregiver.
O. The patient has not expressed an unwillingness to use a power wheelchair in the
home.
REF EDU/0107-37, Rev. B (1HR)
Coverage Criteria
A Group 2 Single Power Option PWC (K0835 – K0840) is covered if all of the
coverage
g criteria for a PWC are met and if:
 The patient requires a drive control interface other than a hand or chin-operated
standard proportional joystick (examples include but are not limited to head
control, sip and puff, switch control); or
 The patient meets coverage criteria for a power tilt or a power recline seating
system (see Wheelchair Options and Accessories policy for coverage criteria) and
the system is being used on the wheelchair; and
 The patient has had a specialty evaluation that was performed by a
licensed/certified medical professional.
 The wheelchair is provided by a supplier that employs a RESNA-certified
Assistive Technology Professional (ATP) who specializes in wheelchairs and who
has direct, in person involvement in the wheelchair selection for the patient.
REF EDU/0107-37, Rev. B (1HR)
Coverage Criteria
A Group 2 Multiple Power Option PWC (K0841-K0843) is covered if all of the
coverage
g criteria for a PWC are met and if:
 The patient meets coverage criteria for a power tilt and recline seating system
(see wheelchair Options and Accessories policy) and the system is being used on
the wheelchair; or
 The patient uses a ventilator which is mounted on the wheelchair; and
 The patient has had a specialty evaluation that was performed by a
li
licensed/certified
d/
ifi d medical
di l professional.
f
i
l
 The wheelchair is provided by a supplier that employs a RESNA-certified
Assistive Technology Professional (ATP) who specializes in wheelchairs and who
has direct, in person involvement in the wheelchair selection for the patient.
REF EDU/0107-37, Rev. B (1HR)
Coverage Criteria
A Group 3 PWC with no power options (K0848-K0855) is covered if:
 The patient's mobility limitation is due to a neurological condition, myopathy,
or congenital skeletal deformity;
 The patient has had a specialty evaluation that was performed by a
licensed/certified medical professional.
 The wheelchair is provided by a supplier that employs a RESNA-certified
Assistive Technology Professional (ATP) who specializes in wheelchairs and
who has direct, in person involvement in the wheelchair selection for the
patient.
patient
REF EDU/0107-37, Rev. B (1HR)
Coverage Criteria
Group 3 – Examples of Neurological, Myopathy, Congenital Skeletal
Deformity
N
l i l conditions
diti
th
Neurological
thatt iimprove
– Cerebral Vascular Accident (Stroke)
– Traumatic Brain Injury
Static neurological conditions
– Cerebral Palsy
– Post Polio Syndrome
– Spinal Cord Injury
Progressive
P
i neurological
l i l conditions
diti
– Alzheimer’s Disease
– Amyotrophic Lateral Sclerosis
– Multiple Sclerosis
– Parkinson’s Disease
– Spinal Muscular Atrophy
Not all inclusive
REF EDU/0107-37, Rev. B (1HR)
Coverage Criteria
Group 3 – Examples of Neurological, Myopathy, Congenital Skeletal Deformity
Myopathies
– Muscular
M
l D
Dystrophies
hi
– Myositis
Congenital Skeletal Deformities
– Spina Bifida
– Osteogenesis Imperfecta
Not all inclusive
REF EDU/0107-37, Rev. B (1HR)
Coverage Criteria
A Group
p 3 PWC with Single
g Power Option
p
(K0856-K0860)
(
) or with Multiple
p Power
Options (K0861-K0864) is covered
 The patient's mobility limitation is due to a neurological condition, myopathy, or
congenital skeletal deformity; and
 The patient meets the coverage criteria for the single power option or
multiple power options respectively (tilt and recline)
 The patient has had a specialty evaluation that was performed by a
licensed/certified medical professional.
 The wheelchair is provided by a supplier that employs a RESNA-certified Assistive
Technology Professional (ATP) who specializes in wheelchairs and who has
direct, in person involvement in the wheelchair selection for the patient.
REF EDU/0107-37, Rev. B (1HR)
Options and Accessories
REF EDU/0107-37, Rev. B (1HR)
Headrest
Attendant Control
Adjustable Height
Arms
Power Recline
Power Tilt
Skin
Protection
Positioning Back
& Positioning
Expanded
Cushion
Controller
Power
ELRs/
Articulating
Foot
Platform
Under Medicare, options and accessories for wheelchairs are covered if the
patient has a wheelchair that meets Medicare coverage criteria and the option
or accessory is medically necessary.
REF EDU/0107-37, Rev. B (1HR)
Coverage Criteria
 The medical necessity for all options and accessories
must be documented in the p
patient’s medical record and
be available to Medicare upon request. An order for each
item billed must be signed and dated by the treating
physician kept on file by the supplier, and made available
upon request.
 Accessories to a wheelchair base must be billed on the
same claim as the wheelchair base.
REF EDU/0107-37, Rev. B (1HR)
PMD Documentation
Requirements
REF EDU/0107-37, Rev. B (1HR)
Documentation Checklist
1. The seven element order signed and dated by the treating physician.
2. The written detailed product description (DPD) of the device base and separately billable
options and accessories signed and dated by the treating physician.
3. Notes of physician visits prior to the face-to-face examinations which document the
progression of the patient’s mobility impairment.
4. The written face-to-face examination by the treating physician. Portion of the face-to-face
examination conducted by an independent physical therapist (PT) or occupational therapist
(OT), if applicable, including an attestation that the PT/OT had no financial relationship with
the supplier.
5. Any other medical records describing the justification for the power mobility device and
separately billable options and accessories. These records could include physician’s office
records laboratory or other test reports,
records,
reports hospital records,
records nursing home records
records, home
health agency records, and records from other health care professionals.
6. The on-site home assessment record.
7. Proof of delivery of the items to the beneficiary.
REF EDU/0107-37, Rev. B (1HR)
(1) Seven Element Order
Checklist







Beneficiary name
Date of the face to face examination
(completion of the face to face exam)
Description of the item ordered
Pertinent diagnosis/condition
Length of need
Physician’s signature (with legible identifier)
Date of physician’s signature
Double CHECK
 Correct date of the face to face.
 Date stamp of when received by the supplier.
 Legible identifier (printed name, etc.).
REF EDU/0107-37, Rev. B (1HR)
(2) Detailed Product Description
(DPD)
Checklist
 MUST include a narrative description (manufacturer and make/model) of each item
separately
p
y billable.
 Must include a start date (Date the physician signed the 7‐Element Written Order).
 Only separately billable items should be listed on the DPD.
 MUST be sent to the physician (after the supplier receives the order, face to face and if
applicable LCMP evaluation).
 MUST be signed by ordering physician prior to deliver.
 The DPD must be signed, dated and received by the supplier (date stamped to prove it)
prior to or on the date of delivery (PMD cannot be delivered without it). Physician
signature indicates agreement.
Double CHECK
 Signed by the ordering physician prior to delivery.
 Date stamped of when received by the supplier .
 Signed by the ordering physician after the 7 element order and the face to
face examination received and date stamped by the supplier (actual stamp).
REF EDU/0107-37, Rev. B (1HR)
(3) Patient’s History/Progression
Physician Chart Notes
Checklist
 Notes of physician visits prior to the face-to-face examinations which document
the progression of the patient’s mobility impairment.
Double CHECK
 No contradictoryy information in the p
previous chart notes.
 Attempted to obtain history, however, none available with relevant information.
REF EDU/0107-37, Rev. B (1HR)
(4) Face-to-Face Examination
Checklist
 Physician’s face to face examination MUST be in
the format of a detailed narrative chart note and
MUST address (A) from PMD LCD
 Supplier/physician generated forms are NOT
acceptable
 LMNs are NOT acceptable
 The physician MUST document the examination in
a detailed narrative note in their charts in the
format that they use for other entries
 The physician’s note MUST clearly indicate that a
major reason for the visit was a mobility
examination (content)
 The majority of the content MUST address the
patient’s mobility limitation(s)
REF EDU/0107-37, Rev. B (1HR)
(4) Face-to-Face Examination
Minimum required information from the ordering physician when there is a LCMP
(PT/OT) evaluation  Symptoms that limit ambulation
 Diagnoses that are responsible for these symptoms
 Medications or other treatment for these symptoms
 Progression of ambulation difficulty over time
 Other diagnoses that may relate to ambulatory problems
 History of falls, including frequency, circumstances leading to falls
REF EDU/0107-37, Rev. B (1HR)
(4) Face-to-Face Examination

If there IS NOT an LCMP evaluation, the physician’s chart/progress notes
must address the patient’s mobility limitations and why the patient cannot
safely/reasonable timeframe use a least costly alternative to perform MRADLs
in their home
home.
=
Face to Face
E
Examination
i ti
REF EDU/0107-37, Rev. B (1HR)
(4) Face-to-Face Examination

If there IS an LCMP evaluation, the physician’s chart/progress notes at a
minimum must address the patient’s mobility limitation (A – mobility deficit
relative to MRADLs) per LCD

p
cannot
The LCMP evaluation must address whyy the patient
safely/reasonable timeframe use a least costly alternative to perform
MRADLs in their home (B - cane/walker, C - manual wheelchair and if
applicable D - scooter per LCD)

The ordering physician must co-sign, date and state agreement or
disagreement on the LCMP evaluation prior to delivery
+
=
Face to Face
Examination
REF EDU/0107-37, Rev. B (1HR)
(4) Face-to-Face Examination
Double CHECK
 Documented in the chart note (NO forms, NO LMN)
 In a detailed narrative format similar to other entries
 MUST address the diagnosis/condition responsible for the mobility
limitation (A)
 Least costly alternatives must be addressed by either the ordering
physician OR the LCMP (PT/OT)
 Attestation of no financial relationship with LCMP
REF EDU/0107-37, Rev. B (1HR)
(4) Clinical Documentation
 Clinical documentation MUST rule out the least costly alternatives (A – C) per
Power Mobility Device LCD
- Safety and/or reasonable timeframe MUST be addressed
REF EDU/0107-37, Rev. B (1HR)
(5) Medical Records
(Other Health Care Professionals)
Checklist
 Any other medical records describing the justification for the power mobility device
and separately billable options and accessories -
Physician’s office records
Laboratory or other test reports
Hospital records, nursing home records, home health agency records
Records from other health care professionals
Double CHECK
 No contradictory information in the medical records
 Attempted to obtain history, however, none available with relevant information
REF EDU/0107-37, Rev. B (1HR)
Quantitative Measures
Evaluation
1. Balance (Sitting / Standing)‐
0, 1, 2, 3, 4, 5
Dependent, Poor, Fair, Good, Normal
2. Strength0/5, 1/5, 2/5, 3/5, 4/5, 5/5 No movement, Trace, Poor, Fair, Good, Normal
Within Normal Limits (WNL) or
Within Functional Limits (WFL)
Grip strength measurement of _____ #
3. Range of motion (ROM)Goniometric Measurement (-40, 20 - 110)
WNL (within normal limits)
WFL (within functional limits)
4. Tone and ReflexesHypertonic, Spastic, Hypotonic, Flaccid,
Fluctuating tone, Athetoid, Ataxic, Tremors
ATNR, STNR, Extensor Thrust, Clonus
5. SensationIntact, Absent or Impairedlight touch, sharp/dull, deep pressure with a
description of the dermatome or size and location
Assessment
1. Unsteady, falls
2. Weakness, decreased or limited
strength
Weak grasp, poor grip
3. Decreased or limited range of
motion, poor reach
4. Stiff, Limp, Uncoordinated, Shaky,
Jerky
5. Numbness, tingling
REF EDU/0107-37, Rev. B (1HR)
Quantitative Measures
Evaluation
6 Pain rates 0 – 10 on the pain scale
6.
Assessment
6 Painful
6.
Painful, has pain
pain, experiences pain
7. _____ liters 02 / minute, 02 saturation levels,
Pulse oximetry readings, Vital capacity,
Respiration rate
7. Short of breath, gasping, wheezing
8. Blood pressure ___/___, heart rate, pulse
8. Chest pain, light headed
9. PosturePelvic tilt, obliquity, rotation
Kyphosis Lordosis,
Kyphosis,
Lordosis Scoliosis
Abduction, Adduction, Flexion, Extension
9. Leaning, Slouching
REF EDU/0107-37, Rev. B (1HR)
Quantitative Measures
Evaluation
10. Ambulates _____ feet with ______ device
Requires max. (75%), mod. (50%), min. (25%),
stand by assistance, contact guard assistance
or supervision to ambulate
Assessment
10. Not an independent ambulator
Not a functional ambulator
Not a safe ambulator
Timeliness? Efficiency? Settings of anticipated use?
11. Propels a manual w/c _____ feet with
Both (B) upper extremities
Both (B) lower extremities
R / L upper and lower extremities
Requires max. (75%), mod. (50%), min. (25%),
stand by assistance, contact guard assistance
or supervision to propel
Timeliness? Efficiency? Settings of anticipated use?
11. Non-functional manual w/c
propulsion
REF EDU/0107-37, Rev. B (1HR)
Evaluation and Documentation
Subjective Information
Objective Information
The patient has difficulty walking and can only
The patient becomes short of breath after walking
walk short distances.
15-20 feet and must stop and rest.
The patient needs power mobility in order to
The patient does not have the stability to walk from
complete MRADLs. He is too unstable to use a
the bedroom to other rooms in the house with
cane or walker and does not have the
either a cane or walker. He has experienced two
endurance to propel a manual wheelchair.
falls in the past month in his home despite use of a
wheeled walker. A trial with a lightweight manual
wheelchair failed. Severe osteoarthritis in shoulders
and wrists has resulted in limited range
g of motion
and propelling the wheelchair more than 15 feet
results in pain rated at 7/10.
The patient has weakness in the upper
Strength in right upper extremity is 3/5 and 2/5 on
extremities.
the left. Patient cannot lift more than 5 pounds.
DME MAC C, Medical Review Power Mobility FAQ, January 26, 2010
REF EDU/0107-37, Rev. B (1HR)
Evaluation and Documentation
If the patient is thought to require a PMD due to respiratory
illness or injury:
Does the patient use home oxygen?
If yes, what is the frequency, duration, delivery system, and flow rate
denoted?
How far does the patient report that she/he can walk or self-propel a
manual wheelchair before becoming short of breath (with best oxygenation
provided)?
Describe the ADLs that make him/her short of breath in the home (with best
oxygenation provided) and the interventions that palliate them.
How have these signs/symptoms changed over time?
http://www.cms.gov/MLNProducts/downloads/MedQtrlyCompNL_Archive.pdf
REF EDU/0107-37, Rev. B (1HR)
Evaluation and Documentation
If the patient is thought to require a PMD due to
cardiovascular illness or injury:
Specifically, describe any clinically significant increased heart rate,
palpitations, or ischemic pain that occurs or worsens when the patient
attempts or performs ADLs within the home (with best oxygenation
provided)?
What p
palliates these signs/symptoms?
g
y p
How far does the patient report that she/he can walk or self-propel a
manual wheelchair before experiencing these signs/symptoms?
How have these signs/symptoms changed over time?
http://www.cms.gov/MLNProducts/downloads/MedQtrlyCompNL_Archive.pdf
REF EDU/0107-37, Rev. B (1HR)
Evaluation and Documentation
If the patient is thought to require a PMD due to
neuromusculoskeletal illness or injury or malformed body
member:
Describe the patient’s impairments. For example, does the patient exhibit
joint/bone signs/symptoms, changes in strength, coordination or tone?
How do these signs/symptoms relate to the patient’s functional state and
the ability to perform ADLs in specific?
How far does the patient report that she/he can walk or self-propel a
manual wheelchair before these signs/symptoms interrupt that activity?
How have these signs/symptoms changed over time?
http://www.cms.gov/MLNProducts/downloads/MedQtrlyCompNL_Archive.pdf
REF EDU/0107-37, Rev. B (1HR)
Evaluation and Documentation
• Records may be corrected if errors were made or additional
information about the already‐completed examination is
needed for clarification.
– When changes to the record are made for such a correction or
addition, a change to the F2F date is not necessary, since all
information arises from the already‐completed F2F examination.
• New information acquired outside of or in addition to the
already‐completed F2F exam, however, changes the date used
for the F2F exam to the date that the ordering physician
incorporates the new information into the F2F.
– If the date of the F2F changes, all requirements that are linked to
the F2F are affected (F2F date on the 7EO, 45‐day document
delivery requirement, 120‐day product delivery date, completion
date of the DPD, etc.). As the F2F date changes, these other
items may be impacted as well.
DME MAC B, FAQ, January 24, 2013
REF EDU/0107-37, Rev. B (1HR)
Evaluation and Documentation
• From a document review perspective, the core issue is
to identify when a change to the F2F represents a simple
correction or addition to the already‐created examination
vs. the addition off new information
f
aside from
f
the
already‐created exam.
• This assessment rests upon the quality of the
information provided by the person making the correction
or amendment in identifying clearly the nature and
source of the added information.
• CMS gives reviewers some latitude to make judgments
but the instructions clearly tell us that inference is never
a substitute for incomplete, unclear or confusing records.
DME MAC B, FAQ, January 24, 2013
REF EDU/0107-37, Rev. B (1HR)
Supplier ATP Appraisal
Checklist
 The supplier must employ a RESNA-certified Assistive Technology
Professional ((ATP)) who specializes
p
in wheelchairs and who has direct,, inperson involvement in the wheelchair selection for the patient.
 Required for any power wheelchair coded K0835 and above.
Double CHECK
 Report should not included clinical viewpoint. Report should focus on product
selection.
 Employment of RESNA certified ATP can be documented by providing a copy of
the RESNA Certificate or a printout from the RESNA website showing credential is
current.
REF EDU/0107-37, Rev. B (1HR)
(6) On-site Home Assessment
Record
Checklist
 Prior to or at the time of delivery of a POV or PWC.
 Perform an on-site evaluation of the patient’s home to verify that the patient
can adequately maneuver the device that is provided.
 There must be a written report of this evaluation available on request.
 Home assessment must be signed and dated by the person performing the
assessment prior to or on the day of delivery.
Double CHECK
 Home assessment cannot be performed (dated) prior to the supplier receiving
(verified with date stamp) the valid 7 element order
DME MAC C, Medical Review Power Mobility FAQ, January 26, 2010
REF EDU/0107-37, Rev. B (1HR)
(7) Proof of Delivery
Checklist
 Delivery ticket with description of item(s) provided along with beneficiary signature
and date received
Double CHECK
 Date of delivery listed on delivery ticket must match the date of service on the
claim (1st month if capped rental)
REF EDU/0107-37, Rev. B (1HR)
Thinking out loud
• What are two things you learned and how
can you relate it to your practice?
• How does this course relate to your
practice setting?
p
g
• How will this course change your behavior
in the future?
REF EDU/0107-37, Rev. B (1HR)
Thank you for your time.
Thank
you for your time.
Any questions?