Stavros
Advocates for Independent Living
Physician Instructions/Checklist for Power Wheelchair and Power Scooter Ordering
The following information is required by Medicare to process an order for a power wheelchair or power scooter.
*Patient sees physician for "Face-to-Face" mobility examination.
*Physician MUST document specific details in patient's medical record/progress notes (see Documentation Checklist for Power Wheelchairs).
*Physician MUST co-sign PT?OT mobility evaluation.
*Physician MUST write a "7 Element Written PMD Order" (see Documentation Checklist for Power Wheelchairs).
*Copies of MD medical record (progress notes) for face-to-face mobility, signed PT?OT evaluation, and 7 Element Written PMD order must be forwarded to Home Health Provider within 45 days of the completion of the face-to-face examination process.
*Following receipt of the above paperwork, the Home Health Care provider will generate a "Detailed Written Order" to be signed by the MD (this must be signed before deliver (within 120 days of completion of face-to-face examination but can be after the 45 days identified above).
*A letter fo medical necessity (line item justification) if appropriate will also be forwarded for physician signature.
Medicare Required Face To Face Documentation Checklist for Power Wheelchairs
Progress Note Checklist:
*MD progress notes must contain the following information
*Indicate that the purpose of the office visit is specifically for Mobility Evaluation.
*Identify that the patient has a mobility limitation in his/her ADL's that require the use of a mobility assistive device.
*Identify what the patient is currently using and WHY it is no longer appropriate.
*List why a cane, walker, manual wheelchair, or scooter (POV) are not appropriate to allow the patient to independently perform his/her ADL's.
*Identify that the patient has the physical and mental abilities to operate a power wheelchair safely in their home.
*IF A PHYSICAL OR OCCUPATIONAL THERAPIST EVALUATION is used to identify the patient's limitations in Mobility Related Activities of Daily Living, the physician must document in the patient's medical record/chart that the PT?OT evaluation was reviewed and agreed upon by the physician.