Putting it All Together
Once the seating & mobility team has gathered all this information, from the potential clinical benefits of using an ultralight chair to the subjective and objective data that supports that opinion, it’s time to put it all together into a claim that will tell your story.
The original definition of assistive technology really came before the Medicare Modernization Act of 2003, before the Mobility Assistive Equipment guidelines, before we started to talk about MRADLs. Originally prescribing assistive technology as the simplest, least-costly alternative. As we evaluated the patient and found more limitations or more issues, then we would start looking toward the more complex, more expensive equipment. Clinical problem-solving is something we all do, and as we adapt to the new funding rules, it’s more important than ever for us to be able to paint that picture for the payor source so they understand how we came to our equipment selection.
The bottom line is even though you can state those outcome findings or objective measures, you must always tie it back to how it will affect the patient’s ability to perform their routine activities and their MRADLs.
The best form of documentation is a concise, detailed evaluation that explains how the features of a K0005 chair will increase your end user’s ability to complete functional daily living activities. Quantitative data such as range of motion, upper- and lower extremity manual muscle tests, and seating mat evaluation results are critical to share with funding sources, so they understand why you are prescribing an ultralightweight frame. Going through the process of ruling out that the end user is able to complete daily activities with the use of a walking device, and/or a lower coded chair, is the best start.
To be sure, the seating & mobility team creates a lot of pieces of information during the assessment and equipment trials process, and the task of choosing what to include can be intimidating.
The therapist and the ATP need to work together closely to make sure they include all the relevant information and documentation. Sometimes, less experienced therapists can get overwhelmed when participating in wheelchair selection, but the data needed for justification is usually the same data they are using to document daily client goals and gauge outcomes in rehab. They simply need to integrate it as part of equipment assessment. The ATP can help by providing examples of success and helping to narrow down choices once the clinical indications have been identified.
Finally, don’t let the upcoming documentation process discourage you and your team from seeking the K0005 solution when you believe it’s warranted.
We want the equipment to become an asset, not a liability. Many people are shortchanged, whether it be by diagnosis or perceived funding limitations, and it results in poor outcomes for the client long-term. For example, some therapists feel that clients with a stroke do not qualify for an ultralight wheelchair. The diagnosis does not, and should not, preclude us from considering an ultralight chair.
Custom-configured ultralightweight chairs can open new doors of opportunity and ability for consumers — and that potential independence is worth fighting for.
We need to look at each client individually. It might be oversimplifying it, but we should not be asking, ‘When should we consider an ultralight,’ but ‘Why shouldn’t we?’ We should give every client the chance and opportunity to have the highest quality of life.