Can I get this paid for? Part 1: general documentation guidelines

Michelle L. Lange, OTR/L, ABDA, ATP/SMS

I personally recommend Dynamic Seating components for the clients I work with, as well as provide education in this area of practice. One question that is often posed to me is, “Can I get this paid for?” My answer – “Yes!” Of course, funding varies by payer, coding, and the direction the wind is blowing. I find that clinicians are often unsure of how to justify the need for this equipment in their documentation. Documentation is key to getting funding approval and so I have compiled some suggested wording for you here. If you require further assistance with documentation, please contact Seating Dynamics or myself for help.

These examples do not replace competent evaluation. Choose the wording that matches an individual’s specific needs. I find it helpful to begin with a brief definition, as reviewers are often unfamiliar with this technology.

“The Dynamic Component (insert specific product name here) moves in response to client force and assists the client back to an upright starting position.

  1. The Dynamic Component is recommended to absorb forces exerted by the client which have led to equipment breakage in the past and/or to prevent future breakage. The dynamic components absorb these excessive forces, protecting the client from injury and the wheelchair frame, seating system, and hardware from breakage. Breakage may result in the client being unable to use their wheelchair and/or seating system until repairs are made.

and/or

  1. The Dynamic Component is recommended to absorb forces resulting from active client extensor tone. By absorbing and diffusing these forces, extensor tone can be decreased. Reducing extensor tone can increase function, sitting tolerance, and conserve energy. Active range of motion is also provided, reducing risk and progression of range of motion losses.

and/or

  1. The Dynamic Component is recommended to provide movement for the client to provide vestibular input, increase alertness, decrease agitation, increase sitting tolerance, and increase function.

and/or

  1. The Dynamic Component is recommended to provide movement for the client against resistance to increase strength and improve postural control.”

 

I hope this sample wording helps when you are writing those Letters of Medical Necessity. Are you having difficulty getting funding for Dynamic Seating components? Leave a comment below describing your experiences. Thanks!

For a Downloadable version of all Dynamic Seating Sample Medical Justification Wording, click here.

Leave a Reply

Your email address will not be published. Required fields are marked *