Know Your Products
Being able to offer data about how a client could benefit from a K0005 — such as how he/she says his/her shoulder pain decreases from a score of 7 to 1 when propelling an ultralight — requires understanding how the ultralight differs from lower-coded chairs, particularly the high strength, lightweight K0004 chair.
Key points to remember about the K0005:
This is the K0005’s ultimate distinction for clinicians and ATPs who need to dial in a chair to very exacting and unique specifications for complex rehab clients.
The adjustable axle plate allows for center-of-gravity (horizontal shift), seat-to-floor height (vertical shift), camber, and lateral axle spacing (inward or outward) adjustments. These adjustments offer a tremendous benefit to our end users when implemented correctly.
K0004 chairs have some ability to adjust, but at a price: You can change a K0004 to have a lower rear seat-to-floor height than front, but you need to change the rear wheel and the casters to accomplish that, which affects the ability of the chair to roll efficiently. When you want to achieve a lower rear seat-to-floor height than the front, that’s a critical feature of the K0005: you are able to accomplish it without changing the roll of the chair.
Seat back options:
There’s also seat-to-back angle adjustment and back height specificity. If you use a K0004 and that back’s too high, it can push the shoulders forward, which changes the biomechanics of the upper body and also affects the client’s ability to efficiently propel and, again, complete their daily activities.
This is probably the most popular factor among consumers, and it’s true: Ultralight frames can weigh far less than lower-coded ones. The key, however, is to underline the importance of that weight savings by tying them back to those MRADLs.
[K0004s] are supposed to be less than 34 lbs., but you can have a K0005 that weighs significantly less. Remember the weight of the total system you’re creating. If you start with 33 lbs. and you add a 5-lb. cushion and a 4-lb. back, then you must look at the effect on the person’s propulsion abilities based on the total weight of the chair. If you start high, based on what you have to add, obviously propulsion efficiency is decreased, there’s more respiratory demand, there’s more fatigue, the whole system is heavier for pushing.
As mentioned, the K0005 isn’t the only type of manual chair capable of being adjusted. It stands alone, however, in its wide range of adjustability.
Study after study shows the importance of made-to-measure chairs in relation to maximizing function and preventing upper-limb injuries. Ultralight chairs are more adjustable, lighter weight, and overall more efficient to propel. While some insurances (such as Medicare) focuses on the ability to change rear wheel position as a differentiating factor — it is much more than that. The ability to change rear-wheel position for optimal propulsion is extremely important, but the type and amount of adjustment is, too.
For complex rehab consumers, seemingly minute adjustments can make a huge functional difference. For some people, proper configuration means moving the axle forward 1/2”.
While some lightweight chairs might offer one or two rear wheel positions, you really aren’t able to fine-tune or optimize for the individual.
You also tend to have more options available for critical components, such as rear wheels, handrims, front wheels, tires, and frame sizes and geometry. All of these options will help maximize someone’s functional potential.
In other words, it’s not just an optimized configuration, but also improved ride that can make the K0005 a much better choice for the full-time self-propeller.
Availability of suspension systems as an option on K0005 chairs can help maximize the client’s sitting tolerance and utilization of their chair throughout the day. When propulsion of a chair without suspension causes undesired tonal reflexes, an elevation in pain or discomfort, or increased fatigue from maintaining functional sitting postures.
Knowing the differences between types of chairs is critical to the documentation process. You must document in the letter of medical necessity and rule out the lesser device and why it does not have the features that will meet your patient’s needs in order for them to complete MRADLs. This is a best practice to justify your recommendations. It’s also important to know the features and benefits of individual products within the K0005 HCPCS code.
Therapists need to understand the differentiating features between the levels of products and also between the products themselves so that they can work with the RTS and the ATP on product selection. The story begins with the therapist’s responsibility to first identify what are the patient’s problems, what are some potential solutions, what are some of the key critical features that you need to make sure that equipment has in order to solve the patient’s problem?
Then you go to actual product selection. You should be able to think through the different levels of features offered by a K0005 and match them to the person’s geometry and clinical factors, like respiratory and cardiac issues, effects on spasticity, and postural stability.