Page 15 - Mobility Management, January 2019
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                                                                                          INCLUSION is an important goal in “It starts at the assumption of ‘What is a HCPCS code and why is it used?’” Stanley
the complex rehab technology (CRT) industry. Innovative seating and wheeled mobility recommended, built and fitted by expert clinicians and providers can support new levels of independence and participation for consumers.
But inclusion can hinder access
to CRT when it’s applied too widely
to Healthcare Common Procedure Coding System (HCPCS) codes, those letter-number combinations intended, according to the Centers for Medicare
& Medicaid Services (CMS), “primarily to identify products, supplies, and services not included in the CPT-4 codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician’s office.”
Many CRT experts believe adjustable wheelchair seat cushion codes are too inclusive, with definitions so broad that large numbers of products apply, even though the products demonstrate varying levels of functionality and don’t allow an “apples to apples” comparison.
Such widely inclusive codes can impact many facets of CRT, from reimbursement to product innovation, clinical outcomes and consumer access.
What’s the Goal of a HCPCS Code?
The four adjustable cushion codes are E2622 (skin protection, adjustable, width less than 22", any depth); E2623 (skin protection, adjustable, width 22" or greater, any depth); E2624 (skin protec- tion and positioning, adjustable, width less than 22", any depth); and E2625 (skin protection and positioning, adjust- able, width 22" or greater, any depth).
Rita Stanley is VP of Government Relations for Sunrise Medical. She
is one of the industry’s most highly regarded and experienced experts on HCPCS coding, coverage policy and funding, and she has a long history of addressing codes that the CRT industry believes are too broad. That includes the adjustable seat cushion codes.
When it comes to widely inclusive codes, Stanley thinks the problem starts at a very elementary level, with varying perceptions of why HCPCS codes exist and what they’re supposed to accomplish.
said. “I believe that [CMS] thinks HCPCS codes, due to regulation or legislation, cannot consider how coding impacts coverage and payment when CMS is assessing code appli- cations. In their minds — and they’ve said this any number of times to me — HCPCS codes are purely a billing mechanism.”
Granted, HCPCS codes are used on CRT insurance claims. But that’s just one way they’re used.
“The reality is [the codes] are also how coverage is developed,” Stanley said. “It’s how payment is developed, and if you don’t delineate product properly [within the codes], you have no way of tracking utilization.”
Comparing Like Products
Tracking utilization — knowing which CRT products are being provided and used — is critical to measuring patient outcomes. But when a HCPCS code is so broad that it includes a number of products with varying abilities and functions, it’s impossible to determine which, if any, of the products are delivering desirable results.
Right now, Stanley pointed out, payors “can tell you how many times that code was
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MOBILITY MANAGEMENT | JANUARY 2019 15
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