Dear List,
I have a 48 year old patient who is in need of a new prosthesis due to
weight gain and she has Medicare. In our office, she is able to
display that she is a K3 level ambulator and does not use any
assistive device. My potential problem is that she also has a
powerchair that she received about a year ago, and we have been told
that Medicare is cross-referencing claims.
I have talked to a PT and she gave me the power wheel chair evaluation
and explained to me her process. In it, some of the questions
include: “what is the pt’s mobility limitation and how does it
interfere with the performance of ADL’s?” “why can’t a cane or walker
meet this pt’s mobility needs?” “how far can the pt ambulate without
stopping?” “what has changed to now require the use of a power
mobility device?” etc. Per the PT, her goal is to prove that the pt
cannot safely and consistently ambulate at least 10 meters (25 feet).
As far as I can tell, if the pt meets the criteria for a powerchair
(and Medicare retains these records for about 5 years to cross
reference claims), then it obviously will contradict my evaluation
that she is a K3 level ambulator. The pt states that she needs the
chair because her arthritis acts up in her sound side knee when it
rains and makes it difficult to get around on those days. Medicare is
not going to care that she only uses it a few days a month. As far as
they are concerned, she cannot ambulate safely for 25 feet.
Has anyone run into a problem with Medicare and K2 or K3 with a pt who
has a powerchair?
I just want to get her taken care of and do my best to avoid a huge
audit. If I had my way, I would put her in a K3 foot and fight the
audit tooth and nail, but if I can try to avoid that, I will.
Thanks in advance.
Rachel Hartsell, CPO, LPO
Spears Prosthetics and Orthotics
Memphis, TN
