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Letter of Medical Necessity-Wheelchair

Kristen Cezat, PT, DPT, NCS, ATP/SMS

September 23, 2020

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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.  


kristen cezat

Kristen Cezat, PT, DPT, NCS, ATP/SMS

Kristen Cezat is a Board-Certified Specialist in Neurologic Physical Therapy, a RESNA certified Assistive Technology Professional as well as Seating and Mobility Specialist.  She currently works as a clinical specialist at Orlando Health ORMC Institute for Advanced Rehabilitation inpatient rehabilitation where her specialties include direct patient care and program development for patients with SCI and other traumatic and neurologic diagnoses.  She received her Doctor of Physical Therapy degree from the University of Central Florida in 2011.  Presentation experience includes PVA funded conference at Orlando Health titled “Spinal Cord Injury Treatment across the Continuum” in 2017 on topics including Seating and Mobility as well as Basic Transfer/Basic Bed mobility techniques and FPTA Spring Conference in 2019 on topic- “My Patient has a Spinal cord injury, what should I do?” She guest lectures annually with the University of Central Florida’s physical therapy program and is clinical faculty for the UCF-Orlando Health Neurologic Physical Therapy Residency Program.  She works with a team at Orlando Health who have obtained grants from the Paralyzed Veterans of America and the Craig Neilson foundation to serve those living with spinal cord injury in the Central Florida community.  She recently received the APTA’s Spinal Cord Injury Special Interest Group Award for Clinical Excellence in Spinal Cord Injury Care or Service in 2020


Related Courses

Outcome Measures in Spinal Cord Injury
Presented by Kristen Cezat, PT, DPT, NCS, ATP/SMS
Recorded Webinar

Presenter

Kristen Cezat, PT, DPT, NCS, ATP/SMS
Course: #3869Level: Introductory2 Hours
  'The detailed explanation of the use of the outcome measures were great;y appreciated'   Read Reviews
This course will review outcome measures commonly used in everyday clinical practice for clients with spinal cord injury and their importance in functional goals. Outcome measures discussed will include the ASIA Impairment Scale, 10 Meter Walk Test, 6 Minute Walk Test, Timed Up and Go, Walking Index for Spinal Cord Injury II, and Berg Balance Scale. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Gait Training in SCI: A Review of Current Research and Clinical Interventions
Presented by Kristen Cezat, PT, DPT, NCS, ATP/SMS
Recorded Webinar

Presenter

Kristen Cezat, PT, DPT, NCS, ATP/SMS
Course: #4165Level: Advanced2 Hours
  'Very good instructor with much experience w/patients with spinal cord injury'   Read Reviews
This course discusses current gait training evidence for clients with motor incomplete and motor complete spinal cord injury. High-intensity gait training, intervention selection for clients with motor complete and incomplete SCI, and assessing the effectiveness of interventions through the use of outcome measures are included. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Rehab Considerations for the Client with Incomplete Spinal Cord Injury
Presented by Kristen Cezat, PT, DPT, NCS, ATP/SMS
Recorded Webinar

Presenter

Kristen Cezat, PT, DPT, NCS, ATP/SMS
Course: #3702Level: Introductory2 Hours
  'Having limited knowledge on treatment of spinal cord injury I found this course very helpful'   Read Reviews
This course will provide a basic comprehensive overview of the management of clients with incomplete SCI. This will include background information on incomplete SCI and acute medical concerns, evidence-based treatment strategies, gait training, wheelchair selection, and outcome measure selection to provide the clinician with basic knowledge/skills that are applicable to clinical practice. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Documentation in Spinal Cord Injury: Letters of Medical Necessity, Goals Setting and More
Presented by Kristen Cezat, PT, DPT, NCS, ATP/SMS
Recorded Webinar

Presenter

Kristen Cezat, PT, DPT, NCS, ATP/SMS
Course: #4481Level: Introductory2 Hours
  'The course was very practical and provided succinct points on the importance of creating individualized goals and using appropriate outcomes measures, and used real-world examples to further emphasize how this might be done'   Read Reviews
This course will discuss documentation across the continuum of spinal cord injury with emphasis on documentation of short- and long-term goals, outcome measures, functional treatment interventions, and procurement of specialized DME including letters of medical necessity (LMNs) for wheelchairs.

Case Studies in Spinal Cord Injury
Presented by Kristen Cezat, PT, DPT, NCS, ATP/SMS
Recorded Webinar

Presenter

Kristen Cezat, PT, DPT, NCS, ATP/SMS
Course: #4520Level: Intermediate2 Hours
  'Good explanations'   Read Reviews
This course discusses case studies of those with different levels and types of spinal cord injury. Case studies include evaluation, outcome measures, intervention selection, goal setting, and outcomes across the continuum.

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