Healthcare Fraud Shield’s Latest Article: Understanding Wheelchair Management

19 May

Most people need a little tutorial on how to use new equipment. This also applies to patients who need new wheelchairs. Enter the service of wheelchair management. In this service, the provider assesses a patient’s need for a wheelchair and/or teaches a patient wheelchair maneuvering skills. CPT code 97542 is the correct procedure code for wheelchair management. The units measure one unit per 15-minute increment1


According to CMS2:This service trains the patient, family and/or caregiver in functional activities that promote safe wheelchair mobility and transfers. Patients who are wheelchair bound may occasionally need skilled input on positioning to avoid pressure points, contractures, and other medical complications. Consider the following points when providing wheelchair management services.


Practice makes perfect! Most wheelchair users will need to practice a bit, but typically no more than a few days of training is enough. Regardless of whether the training took one day or four, the service needs to be documented.The medical record should include the following: 

  • the recent event that prompted the need for a skilled wheelchair assessment;
  • any previous wheelchair assessments have been completed, such as during a Part A SNF stay;
  • most recent prior functional level;
  • if applicable, any previous interventions that have been tried by nursing staff, caregivers or the patient that may have failed, prompting the initiation of skilled therapy intervention;
  • functional deficits due to poor seating or positioning;
  • objective assessments of applicable impairments such as range of motion (ROM), strength, sitting balance, skin integrity, sensation and tone;
  • the response of the patient or caregiver to the fitting and training.

Since it is a timed code, the practitioner should record the time for the visit from start to finish in the notes.  As of April 2021, the Medically Unlikely Edits (MUE)4 show the maximum number of units per day is 8 (2 hours of time). Additionally, only a Practitioner or Facility Outpatient Services can bill for this service, not DME Supplier Services.


What to look for?
When assessing this service for any potential fraud, waste and abuse (FWA), you should look for the following:

  • Excessive units in a given day/compared to other providers;
  • More than 8 units in a day;
  • Patients who don’t have any other wheelchair related claims;
  • Excessive number of dates of service per patient/compared to other providers;
  • Look for services unbundled from CPT 97542 (Per CMS CCI – 36591, 36592, 96523)5

If you have any questions or comments, please reach out to SIU@hcfraudshield.com

REFERENCES

1,5 https://www.aapc.com/codes/cpt-codes/97542

2, 3 Billing and Coding: Outpatient Physical and Occupational Therapy Services (A56566)

4 https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE

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