Page 16 - Mobility Management, September/October 2021

ATP Series
Words Matter: The Language of CRT
being available at the VA [Veterans Affairs], where HCPCS coding and payment don’t apply. But for the broader population, even if you wanted to buy one and pay cash for it, you’d have a real hard time finding that kind of chair available on the market now.”
The second major change caused by the loss of the K0009 code involved adult manual tilt-in-space wheelchairs.
“When [CMS] got rid of the K0009, they modified the defini- tion of the tilt-in-space chair,” Stanley said. “If [the chair] has 20° of tilt or more, now it’s tilt in space.”
That new definition of tilt in space — as little as 20° of tilt, when previously, tilt-in-space chairs were required to provide far more tilt to enable significant weight shifting — has resulted in a wider array of people using chairs in the E1161 code. Back when E1161 chairs had to offer much more tilt, many of its users were completely dependent on others for their mobility. But once the E1161 requirement was changed to just 20° of tilt, this category of wheelchair also became more popular for stroke patients, some of whom will regain some mobility function.
“You really have two buckets of consumers that are going into those chairs, but they’re one code,” Stanley said. “So even if you say tilt in space, are we saying a single tilt-in-space code is sufficient? It makes it really hard to write a policy when you’ve got such a broad range of needs. They used to have it at 40° [of tilt] because evidence
showed you had to have at least 40° of tilt to start to offload, or you had to have a combination of tilt and recline to offload pressure.
“Now you’re all the way down to 20° in a tilt-in-space chair. If you can tilt 20°, you do get that sense that gravity is holding you upright in your chair, which is what those stroke patients need. They don’t need that positioning of 40°, but they do need just enough tilt to say gravity is assisting me to stay upright. But again, very different medical necessity criteria.”
The two different user populations, Stanley added, have led
to an evolution in E1161 wheelchair design: “Now unless you’ve got a manufacturer who’s really focused on that population
and developing some unique technology, E1161 chairs have a tendency to be heavier in their overall weight, though they get really low to the ground, and they have 20° of tilt to help get [clients] positioned in their chair so they can foot propel — while before, most people going into those chairs were predominantly dependent for mobility purposes. It’s very different populations.”
Ultimately, the CMS decision not to identify K0009-coded manual wheelchairs as having unique characteristics has restricted consumer access, Stanley suggested. For ultralightweight chairs, “the real harm came when the decision was made that titanium and composite materials — all materials [were part of] K0005. You can make that decision after the fact because no materials
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