[dchavez]

I need,to bill for a k0821,which is a pmd,it comes with a captains chair. Can anyone hel me out,on chossing the correct code for a seat cushion? The beneficiary has a deformed torso,so we are providing her with a positioning seat cushion ,so he/or she will not slide off chair. Can anyone help?

[HEATHER]

The code you use for a cushion should depend on the manufacturer/model of cushion provided. Its not arbitrary unless you are doing a free upgrade. If you don't know you can either 1. ask the manufacturer or 2. ask the coding center 877-735-1326 (there is also a website but I don't know what that is).

That said - If the patient has a POV or a power wheelchair with a captain's chair seat, a separate seat and/or back cushion will be denied as not medically necessary.

A positioning seat cushion - if that is what you have - (E2605, E2606), positioning back cushion (E2613-E2616, E2620, E2621), and positioning accessory (E0955-E0957, E0960) is covered for a patient who meets both of the following criteria:

1.The patient has a manual wheelchair or a power wheelchair with a sling/solid seat/back and the patient meets Medicare coverage criteria for it; and

2.The patient has any significant postural asymmetries that are due to one of the diagnoses listed in criterion 2b above or to one of the following diagnoses: monoplegia of the lower limb (344.30-344.32, 438.40-438.42) due to stroke, traumatic brain injury, or other etiology, spinocerebellar disease (334.0-334.9), above knee leg amputation (897.2-897.7), osteogenesis imperfecta (756.51), transverse myelitis (323.82).

Check out the entire LCD here for more info on cushions:
http://www.cms.gov/mcd/viewlcd.asp?l...on=47&show=all

Let me know if I can help you any further.

[DMEisgoodfun]

Cushions aren't covered w/ captain seat. Positioning cushions have a code
assigned by PDAC. Run man'f, item # thru their website @
https://www.dmepdac.com/dmecsapp/do/search

[dchavez]

Thank you very much, for your help.