July 10, 2008
Power Mobility Documentation Requirements
A review of power mobility claims and ADMC requests submitted to Jurisdiction C shows continued uncertainty regarding the various assessment and evaluation documentation requirements. The following article reviews this information and includes a reference chart indicating the assessment and exam requirements for the various levels of power mobility.
Face-to-Face Exam
What is It?
The face-to-face examination is a statutory requirement for all power mobility devices (PMD). This exam consists of two separate elements, an in-person visit to the physician for the purpose of requesting a PMD, and a comprehensive medical examination.
Who Can Perform It?
The treating physician must conduct the in-person visit. The comprehensive medical evaluation may be performed by the physician or may be referred to a licensed/certified medical professional (LCMP), such as a physical therapist or occupational therapist, who has experience and training in mobility evaluations to perform part of the exam. If the treating physician has referred the medical examination to a LCMP, the physician must review the findings after receiving the LCMP’s report. In addition the physician must document their acceptance of this report in writing and sign and date the entry.
REMINDER: If the report of an LCMP examination is to be considered as part of the face-to-face examination, there must be a signed and dated attestation by the supplier that the LCMP has no financial relationship with the supplier.
How Should the Findings be Reported?
The in-person element of the face-to-face exam should be documented in a detailed narrative note in the physician’s chart in the format that they use for other entries and clearly indicate that a major reason for the visit was a mobility examination. The comprehensive medical examination may be documented either:
In the physician’s narrative record, if they performed the entire exam; or,
By including the report of the LCMP exam in the office record if the exam was referred.
A supplier generated form must not be used to document either the treating physician’s or LCMP’s exam since a supplier generated form is not a considered to be a part of the medical record.
REMINDER: The supplier must receive a written report of the face-to-face exam within 45 days after its completion and prior to delivery of the wheelchair.
Specialty Exam
What is It?
The specialty evaluation is a written report providing a detailed explanation of why a particular power wheelchair base and each specific option or accessory is needed to address the patient’s mobility limitation.
A specialty exam is a mandatory requirement prior to dispensing a Group 2 Single Power Option or Multiple Options PWC, any Group 3, 4 or 5 PWC, or a push-rim activated power assist device.
Who Can Perform It?
The specialty exam must be performed by a licensed/certified medical professional, such as a PT or OT, or physician who has specific training and experience in rehabilitation wheelchair evaluations. The person performing this exam may, but is not required to be, a RESNA-certified ATP.
REMINDER: The PT, OT, or physician performing the specialty exam may have no financial relationship with the supplier.
How Should the Findings be Reported?
The policy does not prescribe a specific format for reporting the specialty exam findings. However, the report should be in the office or facility’s usual medical record form; it should not be on a supplier-generated form.
Home Assessment
What Is It?
All levels of PMD require that an onsite evaluation of the patient’s home be performed prior to or at the time of delivery. The person conducting this assessment should verify and document, in a written report, that the patient’s typical environment supports the use of a PMD.
Who Can Perform It?
The home assessment can be performed by the supplier (or supplier’s employee) or a practitioner (physician, physician’s employee or LCMP, etc.).
How Should the Findings be Reported?
The policy does not specify a particular format or form to use. The policy, however, does state that the assessments and measurements should include physical layout of the home, doorway width, doorway thresholds and surfaces the device will have to move over.
ATS/ATP In-person Appraisal
What Is It?
As of April 1, 2008, suppliers providing certain wheelchairs as described in the PMD LCD must employ a RESNA credentialed professional and this person must have direct in-person involvement in the wheelchair selection process. For an in-depth review of this requirement, please refer to the recently published article, Power Mobility Devices, FAQ – ATS/ATP Requirements.
Who Can Perform It?
This process must be performed by either a RESNA-certified Assistive Technology Supplier (ATS) or Assistive Technology Practitioner (ATP) who specializes in wheelchairs and is employed by the supplier.
NOTE: The requirement for the supplier to employ a RESNA-certified professional and for this person to have direct, in-person involvement in the wheelchair selection process is not waived if the specialty exam is performed by an ATP. The person performing the specialty exam cannot work for the supplier and the person involved in the ATS/ATP in-person appraisal must have a financial relationship with the supplier. Therefore, one individual cannot meet both requirements.
How Should the Findings be Reported?
There must be evidence in the supplier’s file of direct in-person interaction with the patient by the ATS/ATP in the wheelchair selection process. The documentation must be complete and detailed enough so a third party would be able to understand the nature of the ATS/ATP involvement and to show that the standard was met. Just “signing off” on a form completed by another individual would not adequately document direct, in-person involvement. Also, merely signing a statement such as, “I am a RESNA-certified professional specializing in wheelchairs and had direct, in-person involvement in the wheelchair selection for this patient” does not sufficiently verify that this policy requirement was met. Finally, a home assessment completed by a supplier-employed ATS/ATP would not meet the requirement unless the documentation showed how the ATS/ATP applied the assessments and measurements to the wheelchair selection process.
REFERENCE CHART: PMD EVALUATION/ASSESSMENT REQUIREMENTS
PMD Group HCPCS Code Range Face-to-Face Exam Specialty Exam Home Evaluation ATS/ATP In-person Appraisal
Group 1 POV K0800-K0802 Yes No Yes No
Group 2 POV K0806-K0808 Yes No Yes No
Group 1 PWC K0813-K0816 Yes No Yes No
Group 2 PWC – NPO K0820-K0829 Yes No Yes No
Group 2 PWC – SPO K0835-K0840 Yes Yes Yes Yes
Group 2 PWC – MPO K0841-K0843 Yes Yes Yes Yes
Group 3 PWC – NPO K0848-K0855 Yes Yes Yes Yes
Group 3 PWC – SPO K0856-K0860 Yes Yes Yes Yes
Group 3 PWC – MPO K0861-K0864 Yes Yes Yes Yes
Group 4 PWC K0868-K0886 Yes Yes Yes Yes
Group 5 PWC K0890-K0891 Yes Yes Yes Yes
Abbreviation Key PMD = Power Mobility Device
POV = Power Operated
Vehicle
PWC = Power Wheelchair MPO = Multiple Power Options
NPO = No Power Options
SPO = Single Power Option
Refer to the Power Mobility Devices LCD for additional information on coverage and documentation requirements.
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