Tools & Facts That Can Help
The justification for a K0005 initially sounds quite straightforward.
If you simply review the evidence, it is clinically justified that any client who uses a manual wheelchair for independent manual mobility should be considered for an ultralight chair. The RESNA position paper on ultralight mobility also supports this.
But from there, the process gets more complex — as does the need for the ATP and clinician to back up their professional opinions and choices with plenty of facts.
Documentation should include the client’s functional potential, such as data related to wheelchair propulsion that can be gathered with tools like the SmartWheel and other clinical assessment tools. If you have tried or are tracking multiple wheelchairs, be sure to include this in the justification and tell the funding body that you have tried other categories of equipment and why they don’t work.
Including actual data is important because it adds an extra dimension of evidence to back up the justification argument that’s being made. Justification arguments will always be stronger if they are backed up by both subjective statements and objective data.
As an example of such data, the simplest example of performance data is how much force a person is exerting on the handrim to propel their wheelchair at a functional speed. Tools such as the SmartWheel provide that data in automated reports that are easy for clinicians to include in their justifications. It’s important to show with hard data that ultralightweight chairs really do reduce the amount of force that chair users need to exert to go about their activities of daily living.
If the seating & mobility team doesn’t have access to equipment such as the SmartWheel, there are other ways to gather useful, objective data: Even without high-tech tools, clinicians can use basic observational tools — for example, count the number of push strokes needed to cover a certain distance — that will provide data to support their claims. A lower number of push strokes to cover the same distance in a similar time is also an indication of less exertion with an ultra-lightweight chair.
Funding sources also want to see data supporting the client’s ability to successfully use that ultralightweight chair in the first place.
Does the beneficiary have sufficient upper-extremity function to propel a manual wheelchair? It’s imperative that [clinicians and ATPs] document limitations in strength, endurance, range of motion, meaning the numerical strength testing and range of motion testing. Funders are wanting to see documented the objective measures taken. You must give those objective measures to support your statements and professional opinion.
Don’t forget to cover the environment in which the K0005 will be used. Insurances requires the beneficiary’s home provide adequate access between rooms for the wheelchair to maneuver through. Detailing the end user’s living environment, transportation needs, and mobility-related daily activities are also a necessity to include in a justification letter.
Give your client the chance to share their feelings and discoveries in their own words, too.
An end user’s report that they have an easier time propelling the chair due to rear axle adjustments, or reporting less fatigue or pain while propelling can support your documentation. Activities such as successful transfers, transferring the chair in and out of a vehicle independently, or overcoming thresholds and obstacles with better success are also excellent details to document. If needed, take photos or videos and have available to provide to the funding source if necessary.