We understand that documenting medical necessity can be daunting at times and can vary depending on the type of wheelchair. In order to ensure that your patient qualifies for the items they need, make sure to do the following:
Medicare requires you to state the patient's precise mobility limitation to document why the patient needs a wheelchair. Be specific. Some facts about the patient's condition may seem obvious to us, but since Medicare doesn't see the patient on a daily basis, thus they need a more detailed explanation.
Make sure to state what activities the patient is unable to perform and how their condition prevents them from performing these actions. Explain how using a wheelchair will make the patient more able to complete daily tasks. Also make sure to state that the patient's impairment cannot be resolved by the use of a cane or walker.
Medicare requires that each patient who gets a wheelchair is able to safely use it in the confines of their own home. Not all home arrangements are suitable for wheelchairs, so it needs to be identified that the patient (or a caregiver) is willing and able to safely operate a wheelchair in the home.
If the patient requires a wheelchair larger than the standard size, medical notes must document the patient's seated hip measurement to specify the need for a larger wheelchair.
All patients who qualify for a wheelchair qualify for a general use seating cushion. Patients at a heightened risk for pressure ulcers may also qualify for a moisture reducing skin-protection cushion.
