Documenting medical need for custom seating… part two

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The Ride Custom 2 Cushion is made specifically to match each individual’s unique shape to help decrease long-term skin risk and aid in sitting stability for improved functional performance.

In our last post, we discussed Medicare’s documentation requirements for custom wheelchair backs and cushions.  Here we continue the series…

Part Two

In the written therapy evaluation — why Ride Custom over prefabricated cushions and backs?

The beneficiary may present with: specific body measurements, significant postural deviations, contractures, pelvic tilt, obliquity, rotation, etc. that cannot be accommodated by a prefabricated cushion or back. 

These presentations should be well documented to demonstrate the reason a prefabricated cushion or back will not provide sufficient skin protection and/or postural support.  Documented trial and failure of lower level equipment is beneficial.

Example:  Jane Doe presents with a very pronounced anterior pelvic tilt, a left pelvic obliquity, a left lumbar convex scoliosis, a right convex thoracic scoliosis, a marked thoracic kyphosis, and a forward head. Her lower extremities assume a position of abduction. Her legs exhibit a leg length discrepancy with the right lower extremity being shorter than the left. 

There are no prefabricated wheelchair cushions that will accommodate these postural deviations to provide sufficient stability and pressure management. There are no prefabricated backs that will provide accurate contour to accommodate and support Jane’s posture. 

With lack of sufficient pelvic and trunk support, Jane is at risk for developing progressively more severe postural asymmetries as well as pressure injuries. In addition, a poorly fitting prefabricated seating system will severely limit Jane’s ability to independently perform mobility-related activities of daily living. 

A Ride Custom 2 Cushion and Ride Custom Back will be made specifically to match Jane’s complex shape, helping to decrease long-term skin risk and aiding in sitting stability for improved functional performance.

Continue reading, go to part three.

If you need assistance with documentation review for your Ride Custom Back and/or Cushion order, we can help, and at no cost to you!  Contact our Reimbursement Department at (866) 781-1633 x 312.

 

Documenting medical need for custom seating… part one

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Ride Custom Cushion and Back made for a pediatric client.

Navigating the U.S. Medicare guidelines for documenting the medical need for custom seating can seem daunting.  We’ll break it down for you here.

Part One

To start, Medicare requires that a beneficiary needing custom seating is seen by a Physical or Occupational Therapist to evaluate the seating needs, in addition to a physician. The documentation generated by the physician and therapist will need to contain three primary pieces of information:

  1. The beneficiary meets Medicare’s coverage criteria for the wheelchair on which the seating will be installed.
  2. The beneficiary’s condition and diagnosis meet Medicare’s criteria for custom seating. Specifically:
    1. For custom backs – there are documented, significant postural asymmetries that are the result of a qualifying diagnosis.
    2. For custom cushions – there is a documented, current pressure ulcer or history of pressure ulcer on the lower back, sacrum, hip or buttock, OR documented absent/impaired sensation in these same areas, OR documented inability to perform a functional weight shift, as the result of a qualifying diagnosis.
  3. A statement clearly explaining why a prefabricated seating system will not sufficiently meet the medical need of the beneficiary. (This piece of information cannot come from the physician alone, it must be in the written therapy evaluation).

Continue reading, go to Part Two!

If you need assistance with documentation review for your Ride Custom Back and/or Cushion order, we can help, and at no cost to you.  Simply contact our Reimbursement Department at (866) 781-1633 x 312.