Question
What needs to be included in a letter of medical necessity for a wheelchair?
Answer
We need to document the evaluation of the client's systems including both neurologic and orthopedic, their postural assessment, and their level of function. We can't assume that our funding source is going to approve something just because the client has tetraplegia or paraplegia. We have to state the obvious.
- State that your client can't stand or ambulate with any assistive device.
- State that your client is unable to use a lesser cost manual chair because
- The client can't propel a manual wheelchair, because...
- if you're are advocating a power wheelchair, document why the client is unable to use a scooter because...
Those things have to be stated clearly for the funding source or you're going to get a denial just based on that. I like to include that my client is willing to use the recommended complex rehab technology that I have recommended and they can do so safely. That's very important to funding sources.
We need to do a detailed justification of how the spinal cord injury affects the client and how the recommended complex rehab technology will assist with
- Functional activities of daily living
- Mobility
- Positioning/posture
- Management of their secondary effects of their spinal cord injury such as orthopedic hypotension, autonomic dysreflexia, intermittent catheterization, etc.
We need to have a clinical and medical justification for every aspect of the chair that we are recommending.
In addition to the letter of medical necessity, we're also going to need a few things that change over time. So you want to make sure you're up-to-date with the CMS guidelines and your local and national coverage determination of mobility assistive equipment. We need a statement of concurrence with the physician of the prescribing equipment that you have recommended as well as his or her signature. A statement of financial independence of the PT or OT from the vendor, there is needed. There also needs to be a face-to-face evaluation from the physician and a prescription from the physician. Additional documentation will be required if prescribing a power wheelchair. You can write the best letter in the world, but if you don't have all those things in place, then the chair itself can be denied.
