Prescribing Wheelchairs - Info For Clinicians & Therapists
Prescribing the optimal piece of equipment can improve the function and quality of life for an individual.
The right mobility device improves independent mobility, psychosocial and physical well-being. Prescribing the incorrect equipment can lead to fatigue, discomfort, loss of independence, and equipment abandonment. Clinicians and suppliers are key participants in identifying the least costly equipment that fully meets a user’s mobility and medical needs. Documentation of the clinical findings matched to the appropriate equipment is a clinician’s most powerful tool in advocating for their client’s independence.
Power wheelchairs are classified by groups. The bottom of this page has a reference guide that can help to identify the features that are necessary for your client’s mobility needs.
How to Document
A letter of medical necessity for a power wheelchair should contain the specific mobility limitations, how they affect ADL and IADL performance, and why lesser-costly mobility devices (cane, walker, manual wheelchairs, or scooter) cannot appropriately meet the client needs. A full mobility assessment of abilities and limitations should be documented in this evaluation. Mobility examination should cover transfers, ambulation, ability to propel a manual wheelchair, and ability to operate a power wheelchair, including safety, timeliness, and quality as it relates to ADLs.
Documentation is crucial in explaining to the patient’s insurance provider why a cheaper equipment option is not appropriate for the patient. Wheelchair & Walker Rentals can help guide your clinicians anytime they might require help with documentation. Insurers depend on the clinician to help them understand why the equipment being requested is the best choice for the client. When clinical notes state a patient can propel a manual wheelchair but a powerchair is being requested, a clinician must justify and explain the following:
- The client is only able to tolerate a manual wheelchair for a few hours while he can stay up for 8 hours in a power wheelchair
- A power wheelchair for that client reduces the need for paid caregivers
- The patient has skin issues and cannot do independent pressure relief
When possible, the client should try a demonstration of equipment that is similar to the recommended seating and mobility device being requested. This allows the clinician, client, and supplier to observe and document the impact of the prescribed equipment. Thorough documentation allows the insurers to get a better view of what we see in our evaluations and agree with our findings.
Once all lesser costly options have been successfully ruled out, a clinician may then document which mobility device best meets their client’s medical needs. The table listed on the last page provides a brief explanation of each. Deciding between a group 2 and group 3 power wheelchair without an immediate need for multiple powered seating functions can be challenging for a clinician. Some things to consider:
What if a client only requires tilt?
Vibration-dampening suspension is an important aspect of a Group 3 power wheelchair to consider. High magnitude and long duration low magnitude vibrations have been found to be harmful to the human body (Garcia-Mendez, et al., 2013). Wheelchair users are exposed to vibrations that exceed these standards on a daily basis with minimal ability to lower their exposure without limiting their functional independence (Requejo, Maneekobkunwong, McNitt-Gray, Adkins, & Waters, 2009).
If the client is a full-time wheelchair user, what are the potential impacts of the constant encounters with thresholds and uneven surfaces they encounter on a daily basis? Can vibrations negatively impact hardware (such as spinal fusions)? What about pain or spasticity? How does this impact independence or even the ability to tolerate sitting in the chair for hours per day? If they cannot tolerate the chair, does it increase the need for caregiving services?
What if a client has a progressive neurologic disease but doesn’t need the group 3 feature yet?
Medicare covers group 3 power wheelchairs for all persons with a mobility-limiting neurologic diagnosis, congenital skeletal deformity, or myopathy. Some private insurers want the documentation to explain why a group 3 is not appropriate. Group 3 power wheelchairs are modular, meaning you can add power seating functions and alternative drive controls later.
A client with ALS may still be able to walk short distances, but in the lifetime of a power wheelchair (5 years minimum), that user will likely need an alternative way to drive other than a standard joystick. They will likely need power seating functions. While insurers do not cover items for future use, they do not want to purchase a new wheelchair prematurely. They will support the modularity of the group 3 power wheelchair when a client is likely to have a decline in function, as long as that prognosis is documented.
Advocating for the most appropriate power mobility device is crucial to a client’s independence. Knowing the functional differences between groups of power wheelchairs allows clinicians and suppliers to guide the prescription process as well as provide the least costly device that fully meets their client’s needs while keeping them safe.
Accurately documenting needs and ruling out inappropriate devices enables the insurance to understand the client’s function and provide the equipment that is tailored to each client’s needs.
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With a wide selection of wheelchairs on offer and decades in the field, our business is confident in our ability to provide the best wheelchair for your patient. We cherish the ability to help people take control of their mobility and would love to work with you for the benefit of your patient.
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