Page 14 - Mobility Management, September/October 2021

ATP Series
Words Matter: The Language of CRT
decision to eliminate the K0009 code caused a number of ripple effects. Most immediately, it forced K0009-coded wheelchairs into other codes... regardless of how appropriate the fit was. Ultralightweight wheelchairs with the K0009 code were relegated to the K0005 code, for example.
K0005 had been casually used to mean ultralightweight wheel- chair before the K0009 code was discontinued... but making the K0005 code seem synonymous with ultralightweight chairs — all ultralightweight chairs, even those custom built for a single person and therefore more complex and expensive to make — might have led payors to conclude that all ultralightweight chairs were more or less the same in design, function, and cost.
Rita Stanley, longtime CRT policy and funding expert, pointed out how K0005 — used not as a code, but as the name of a type of wheelchair — could lead to confusion.
“If you just refer to it as ‘Oh, that’s a K0005’ — first of all, most people don’t speak HCPCS codes, so it’s like ‘What’s that?’” she said. “But also, when you look at the HCPCS code set, you’ve got K0001, K0002, K0003, K0004, and then K0006 and K0007 that are classified as standard manual wheelchairs. And in the CRT arena, you basically have an E1161 [manual adult-sized wheelchair, includes tilt in space] for a broad range of tilt in space now, and you have the K0005, which is everything else. When you look at the
products that are code verified on the PDAC Web site, you’ve got a broad array of technology with anything from minimal rear- axle adjustment, which has no definition in the HCPCS code, all the way to things that can be basically custom ordered from a manufacturer and built to those specifications.
“If you say to somebody, ‘You need a K0005,’ that’s a huge bucket that you offered up.”
Then a few years after the K0009 elimination, there was a major change involving the K0004 (High-strength, lightweight) wheelchair), Stanley added.
“Years ago, pre-2016 when the entire country dropped in reimbursement for high-strength lightweight chairs, you could get chairs that had minimal adjustment,” she said. “But back when we were talking about revising manual wheelchair codes, there was some discussion about a positioning chair, a chair with limited adjustability. It was really those chairs in the K0004 code that were borderline moving-into-an-ultralightweight category. They missed [being coded as K0005 wheelchairs], but they still had a lot of components that were adjustable.”
But given capped rental payments for K0004 wheelchairs, “Now you can’t provide those [more adjustable] chairs for $49 a month,” Stanley said. “So a lot of the manufacturers have either discontinued them completely or they’re pretty much limited to
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