Wheelchair content Flashcards
Players in wheelchair service delivery
client and family caregivers
therapist - PT or OT
physician
DME/CRT supply company
-CRT- complex rehab technology
supplier (CRTS with ATP and or SMS certification)
-CRTS: complex rehab tech supplier
-ATP: assistive tech professional (must be present on assessment according to medicare (or SMS))
-SMS- seating and mobility specialist
CRT technician - complex rehab technology
Types of certifications for assistive tech:
RESNA - Rehabilitation Engineering and Assistive Technology Society of North America offers two types
–ATP: assistive technology professional
–SMS: seating and mobility specialist
ATP VS SMS EXAM:
-The ATP exam is broad-based covering all major areas of assistive technology, the SMS exam is focused specifically on seating, positioning, and mobility.
Identification of wheelchair need
TYPES OF NEED:
-new wheelchair user: unable to walk safely and functionally in environments where they need to be mobile
-existing user: wheelchair no longer meets needs
–> due to change in condition, growth, or disrepair of equipment
–look at seated posture, skin breakdown, functional mobility
WHO CAN IDENTIFY NEED?
-client, family
-DME/CRT company
-physician
-other health prof, school staff
-treating PT or OT
Assessment for wheelchair
PERFORMED BY:
-PT or OT
–medical fucntional need
–primary problems identified
–seating and mobility objectives and goals
–POC
-supplier
–therapist and supplier together determine necessary features for patient’s goals –> match to tech
–make recommendations of tech
-physician (must be face to face)
Eval by PT or OT includes:
background
personal function
mobility function
physical assessment
-establish initial goals and POC for assessment process
Eval by CRTS or ATP, and therapist includes
seating simulation
special tests/product trials
final prescription/intervention plan
-go through the order form together if possible
-establish and document health concerns and functional impairments to provide a rationale for the recommended mobility device and accessories
-establish final POC for implementation and follow-up phase
Who is involved in finding auth/documentation?
PT or OT
supplier
physician
DME/CRT company
What is the order of least costly to most costly assistive devices according to Medicare?
Ambulation aids
Standard manual wheelchair w/ minimum adjustability
fully configurable MWC
power scooter
power wheelchair
** justify why less costly version does not meet person’s medical and functional needs
CMS documentation requirements for an assistive device
1.) Prescription and 7-element order
2.) Detailed product description
3.) Chart Notes of face-to-face exam by a physician
4.) Clinical documentation
–face-to-face exam form or report (physician or
therapist)
–specialty eval form or report (by therapist)
5.) Home assessment report
PHYSICIAN’S ROLE DOCUMENTATION
-face-to-face exam
-7 element order
-refer to a therapist for completion of F2F or specialty eval
SUPPLIER’S ROLE DOCUMENTATION
-tech assessment with a therapist if needed
-detailed product order
-home assessment report
PT/OT ROLE DOCUMENTATION
-specialty evaluation report or form
SUPPLY COMPANY’S ROLE DOCUMENTATION
puts together a full packet of ALL the documentation, and submits to the insurance company
What is the specialty evaluation performed by the physical therapist?
-typed or handwritten
-represents therapy eval and technology assessment t
-no one specific form is accepted
-must be hand-signed by YOU and hand-dated by you
-Report or Form must attest that you completed the form/did evaluation and that you have no financial relationship with the
supply company providing the wheelchair
** DME/CRT company or CRT supplier BEST source of info on what is needed from you as a therapist
THINGS TO DOCUMENT:
-findings from the eval
-results of simulation or product trials
-less costly alternatives and why they cannot address the client’s medical/functional needs
-address payers coverage criteria for the type of wheelchair and accessories recommended
Who is involved in the wheelchair implementation process?
PT and OT
supplier
technician
DME/CRT company
The implementation process for wheelchair
shape capture for custom contoured seating -> PT has a role in making sure the client is sitting in an optimal resting alignment during shape capture and optimal postural alignment
Order equipment (supply company)
Equipment set-up (technician)
Fittings/delivery
-a person must be seated
-fit is checked and numerous adjustments made
-may need more sessions for fitting before delivery
-check to make sure all features are specified and all objectives met
Training for implementation
Training of consumer and/or caregiver in proper positioning as well as operation care and maintenance of equipment –> (can be done by PT/OT, supplier and/or technician)
-transfer or WC training by PT or OT
Follow-up process for wheelchair fitting
Adjustments and modifications
-change device properties, need an original evaluating team
-PT or supplier
Repairs and Maintenance
-not altering device properties, does not require clinical judgment
-technician performs
Reassessment
-assess whether objectives are being met so equipment can be modified or adjusted to reflect progress or changing status of individual
-done by PT/OT or supplier
Billing for wheelchair fitting process
Assessment Phase: 2-3 sessions
Tech Assessment
-additional sessions required to complete wheelchair assessment or if billed with initial PT eval need to apply 59 modifier
Follow-up phase: 1-3 sessions
-fittings, delivery, and training
-97542 wheelchair management
-97535 self-care/home management
-we write POC to cover assessment and follow-up phases of service delivery
-must update POC for initial visit cause there is a 2-3 month delay before follow-up phase
-home modifications are often not covered by insurance
-Medicare does not cover a backup device
Body segment angle for hip flexion and extension joint motion
thigh-to-trunk angle
Body segment angle knee flexion and extension
thigh to lower leg angle
