Family physicians who need to prescribe power mobility devices, or PMDs, for their patients who have ambulation and mobility difficulties that impair their ability to perform activities of daily living in the home now have a checklist that can aid them during the face-to-face examination that is part of determining eligibility for Medicare coverage of such devices.
According to CMS, for a patient's PMD to be covered by Medicare Part B, physicians must provide the medical equipment supplier with the requisite prescription and portions of the patient's medical record that support the medical necessity for the PMD. As part of documenting the need for that PMD, the physician must conduct a face-to-face examination, which consists of a personal visit and a medical evaluation.
Presented as part of a recent MLN Matters(www.cms.gov) article, the checklist guides physicians to include a detailed description of required items in the patient's medical record. For example, the checklist says the medical record should include a history of
- signs and symptoms that limit ambulation,
- diagnoses that are responsible for the signs and symptoms,
- medications or other treatments prescribed for the signs and symptoms,
- progression of ambulation difficulty,
- other diagnoses that may relate to ambulatory problems, and
- a history of falls.
In addition, the checklist flags physicians about physical exam findings that should be included in the patient's medical record, such as information on height and weight, strength and balance, and the results of musculoskeletal and neurological examinations. Details are vital in assessing whether the physical examination findings support a patient's' need for a PMD, according to CMS, and physicians should describe the patient's ability to transfer or walk and include specifics about mobility problems associated with respiratory, cardiovascular and neuromusculoskeletal illnesses.
"This is what they need to include in their documentation to provide enough information to support a prescription for a PMD," Cynthia Hughes, C.P.C., an AAFP coding and compliance specialist, told AAFP News Now.
"This has not been clear in the past and had put both the DME (durable medical equipment) company providing the PMD and the physician at risk in the event of an audit," she added.
After the face-to-face examination is completed, physicians may write the prescription, which includes seven elements. The medical documentation and the prescription then are forwarded to the PMD supplier within 45 days after completion of the face-to-face encounter.
CMS stresses that the checklist is intended as a guide and does not replace the underlying medical records. As such, its use confers no guarantee that a patient's PMD claim will not be denied.