Quantum Rehab 600E User Manual

Sunrise Medical eConferenceUnlocking the Mystery of the new PMD PolicyDecember 2006

Supporting Documentation Medical history leading to need for PMD  Clinical progression Intervention trials and results If already using MAE, what

Supporting Documentation Reasoning lower level MAE cannot improve or eliminate their mobility limitations Description of time taken to accomplish MR

Progressive Diseases Medicare will pay for “future needs” 6-12 month “window” Must have definable progressive disease Must document “decline” of c

CMS Power Codes 64 New Codes Coding by performance Coding by features: Weight capacity Portability  Seat type Power seat options Basic Equipmen

Performance CharacteristicsGroup 1 Minimum Top End Speed - 3 MPH Minimum Range - 5 miles Minimum Obstacle Climb - 20 mm Dynamic Stability Incline

Power Wheelchair GroupsGroup 1 - Light DutyDesigned for intermittent use indoorsGroup 2 - Basic Daily Mobility Designed for daily use indoorsGroup 3 -

Power Mobility Device  Basic Coverage Criteria Patient has mobility limitation that significantly impairs MRADL abilities Prevents ability to accom

K0800—K0808, K0812Power Operated Vehicle Patient meets basic PMD coverage criteria Ability to independently stand and pivot : required to enter and

POVGuardian Trek 3 Guardian Trek 4

Group 1Light Duty: Designed for intermittent use indoorsPerformance Criteria Minimum Top End Speed - 3 MPH Minimum Range - 5 miles Minimum Obstacle

DisclaimerThis slide presentation is intended to be viewed in conjunction with an audio component and represents the highlights of the new Medicare Po

Power Wheelchair Supporting Documentation Can the patient physically use a scooter but their home environment is unsuitable for such a device? Clear

Group 1 Power WheelchairK0813 – K0816Coverage Criteria Patient meets basic PMD coverage criteria Patient does not meet coverage criteria for POV Pa

Group 1 PMD K0816Invacare At’mShopriderJiffy

Group 2Basic Daily Mobility : designed for daily use indoorsPerformance Criteria Minimum Top End Speed - 3 MPH Minimum Range - 7 miles Minimum Obst

K0820 - K0829Group 2 Power WheelchairCoverage Criteria Patient meets basic PMD coverage criteria Patient does not meet coverage criteria for POV Pa

K0823Group 2 Captains Seat Standard Weight CapacityQuickie MelodyQuickie FreestyleInvacare M41Pride Jet3 UltraQuickie Rhapsody

K0822Group 2 Rehab Seat Standard Weight Capacity Non-portable Can use same base as Group 2 Captain’s Seat Rehab seat requires qualification for pr

K0835-K0840Group 2 Single Power OptionCoverage Criteria Patient meets all above criteria Patient requires alternate drive control OR= any drive cont

Quickie Freestyle M11/F11Invacare M71K0835Group 2 Single Power Option Sling Solid Seat Back 300# weight capacityPride Quantum 610Quickie Rhapsody

K0841-K0843 Group 2 Multiple Power OptionCoverage Criteria Patient meets all above criteria Patient requires power seating systems or= Tilt and rec

Meeting Objectives Understand the new power wheelchair code system  Understand how to qualify your client for power mobility (Local Coverage Determ

Quickie Freestyle M11/F11Pride Quantum 610K0841Group 2 Multiple Power Option 300 lb weight capacity Sling/Solid Seat Back

Multi-Infarct Dementia K0822-Group 2 Rehab Seat Poor UE/LE strength, Fair ROM Incontinent; grade 2 left ischial pressure sore Æ skin protection cus

 Bilateral above knee amputee, CAD Fair ROM, Poor sensation Posture eval: post pelvic tilt, obliquity Unable to propel properly configured manual

Group 3Complex Rehab : designed for complex disabilities - indoor usePerformance Criteria Minimum Top End Speed - 4.5 MPH Minimum Range - 12 miles

K0848-K0855Group 3 No Power Option Patient meets basic PMD coverage criteria Patient does not meet coverage criteria for POV Patient or caregiver h

Definitions Myopathy – disease of muscular origin MD 359.0 Neurologic condition – disease of nervous system MS 340. Quadriplegia 344.0 Congenita

Quickie RhythmQuickie Freestyle M11/FllQuickie GroovePermobilC300 PSOInvacare M91K0848Group 3 No Power Options 300 lb weight capacity Sling/Solid Se

K0856—K0864Group 3 Single Power Options Patient meets all above criteria Patient requires alternate drive control or Patient requires power seating

Invacare TDX SP CGQuickie Freestyle M11/F11Quickie Rhythm M3 SCK0856Group 3—Single Power Option 300 lb weight capacity Sling/Solid Seat BackPride 60

Quickie Groove F3/R3 HDQuickie Rhythm M3 HDQuantum 6000 HDInvacare TDX SP CG HDK0858Group 3 HD Single Power Option 301-450 lb weight capacity  Sling

National Coverage Determination Effective July 5, 2005 Algorithmic approach to determine eligibility for all MAE Canes, walkers, crutches, manual a

K0861—K0864Group 3 Multiple Power Option Patient meets all above criteria Patient requires power seating systems or Patient requires ventilator mou

Quickie Rhythm M7Quickie Groove F7/R7 Quantum 6000Invacare M91PermobilC300-CS1K0861Group 3 Multiple Power Option 300 lb weight capacity Sling/Solid

Danielle Cerebral Palsy Æ neurologiccondition Poor volitional control –movements dictated by tone/reflexes Poor motor control UE, LE trunk Unable

 Requires expandable electronics for switch control E2399 – expandable electronics E2377 specific for expandable electronics in effect jan 1, 2007

K0856 Group 3 SPO  DX: Guillian Barre Æ neurologiccondition Unable to propel manual wc Strength 1/5 LE 3/5 UE Fair sitting balance Unable to

Kevin C5 Quadriplegia Æ neurologiccondition ROM WFL Trunk/LE strength 0/5 Biceps 4/5 Wrist/ triceps 0/5 Transfers via transfer board Absent sen

K0856 Group 3 Single Power Option E1002- power tilt  K0737 - adjustable skin protection & positioning cushion Jay 2 cushion ICD-9: 344.1

K0868—K0886Group 4 Wheelchair has added capabilities that, by Medicare’s definition, are not necessary for use in the home Performance Criteria Spe

State government agencies, including Medicaid, are required to consider community mobility needs. Most are NOT bound by Medicare’s “in the home”restr

Outside The Home  School Work MRADL’s Grocery Pharmacy

Final Rule For Power Identifies documentation and evaluation criteria for power mobility devices (PMD) Requires face to face examination for prescri

Quickie Groove R4 BDQuickie Rhythm M4 BDInvacare 3G ArrowPermobilC500K0868Group 4 No Power Option 300 lb weight capacity Sling/Solid Seat Back

Quickie Groove F4/R4/R5Quickie Rhythm M4Invacare Torque SEK0877Group 4 Single Power Option 300 lb weight capacity Sling/Solid Seat Back

Sonny Diagnosis: Spastic Cerebral Palsy, flexion  Contractures B/L UE’s and B/L LE’sExtremely high toneR pelvic obliquityScoliosisUnable to

K0877 Group 4 SPO K0877 Group 4 SPO Necessary for outdoor mobility E2399 expandable electronics  Required for specialty control use E2399 - exp

Sara Multiple Sclerosis UE strength 1/5 LE strength 0/5 Absent sensation Skin breakdown – unable to perform pressure relief Æ power tilt Unable

K0884 Group 4 MPO K0884 Group 4  Works in community Wheelchair used as transportation to grocery, pharmacy E2399 - expandable electronics Allow u

Code specifies <125lbs weight capacityGroup 5 K0890 &K0891 K0890 Patient meets basic PMD coverage criteria Patient is expected to grow Speci

What is Sunrise Doing To Help ? Rita Hostak – VP Government Relations NCART President Dr Robert Hoover –SVP Global Clinical Services Sunrise Medic

Helpful Websites: NCART – www.ncart.us www.complexrehab.org AA Homecare - www.aahomecare.org

Regulatory WebsitesDME MAC Region A www.medicarenhic.com Region B www.adminastar.com Region C www.cignagovernmentservices.com Region D www.nori

Face to Face 45 Day WindowScenario 1 Client has face to face with MD, MD writes order 45-day window begins with date of MD evaluationScenario 2 Cli

Regulatory Information www.cms.gov SADMERC - www.PGBA.com Click on "Other Partners“ Æ“SADMERC”Æ “Product Classification Lists” Click on “Prov

Reference “Tools” from Quickie www.sunrisemedical.com Click the Power Coding Update Button on the Home Page NEW Quickie Power Wheelchair Reference

Face to Face45 Day Window2Scenario 3 Client has face to face with MD MD refers client to PT/OT for further evaluation Client re-visits MD for follo

Doctor’s OrderOrder must include:1. Client name2. Client diagnoses that relate to need for PMD3. Description of items4. Length of need5. Date of face

Supporting Documentation Needed  Physician progress notes LCMP evaluation results (PT/OT or physician with experience in mobility devices) required