Ordering a Walker

• The patient must have a face to face visit (Not Telemedicine) 

• The patient must have a prescription with specific type of walker i.e non wheeled, front wheeled, four wheeled walker with seat etc.

• The patients height and weight must be within the note, or on the prescription

• The following information must be contained within the chart note:

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The patient has mobility limitation that significantly impairs his/her ability to participate in one or more mobility-related activities of daily living in the home. The functional mobility deficit can be sufficiently resolved with the use of a walker and the patient is able to safely use the walker. 

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Ordering a Hospital Bed

• The patient must have a face to face visit (Not Telemedicine) 

• The patient must have a prescription with qualifying diagnosis

• The patients height and weight must be within the note, or on the prescription

• The following information must be contained within the chart note:

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​Patient requires positioning of the body in ways not feasible with an ordinary bed. Patient requires a semi-electric hospital bed for frequent body position changes to alleviate pain and prevent skin breakdown. 

OR

Patient requires positioning of the body in ways not feasible with an ordinary bed. Patient requires a semi-electric hospital bed for frequent body position changes to alleviate pain and prevent skin breakdown. Patient requires a semi-electric hospital bed for the head of the bed to be elevated more than 30 degrees due to _________(ex. CHF, COPD, or problems with aspiration)

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Bed Accessories

**Trapeze--if ordering a trapeze this must be included within the chart note:

"Patient requires trapeze to change body position while in hospital bed"

We would also need the prescription to include the trapeze.

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NOTE: If patient weighs more than 350 pounds it must be included within the chart note that they require a bariatric bed as they weigh "X" amount. 

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Ordering a Hoyer Lift

• The patient must have a face to face visit (Not Telemedicine) 

• The patient must have a prescription that states a Hoyer Lift with Sling is being order. As well as height, weight and qualifying diagnosis. 

• The following information in this format must be contained within the chart note:

• Patient requires Hoyer Lift in order to transfer between bed and chair, wheelchair or commode. Without the use of a lift, the beneficiary would be bed confined due to _____dx_______.

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Ordering a Nebulizer

• The patient must have a face to face visit (Not Telemedicine) 

• The patient must have a prescription with qualifying diagnosis

• The following information in this format must be contained within the chart note:

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Patient has a respiratory condition of _______(ex. COPD etc.) that requires a nebulizer to administer inhalation drugs. Medication prescribed is _______(ex. DuoNeb, Albuterol, Ipratropium Bromide etc.) to be taken _________(ex. BID, QID etc)

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Ordering Nocturnal Oxygen

• The patient must have a face to face visit (Not Telemedicine) with prescribing physician AFTER the Overnight Oximetry is completed

• The patient must have a prescription that includes liter flow

• The following information must be contained within the chart note:

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Patient has a respiratory diagnosis of (ex. COPD etc) Patient's oxygen saturation is _______(ex. 88%) on room air during sleep for five minutes or greater. Alternative treatment measures have been tried and considered ineffective. Patient requires home oxygen concentrator at _____(ex 2 liters per minute, please ensure it matches liter flow on RX) liters per minute via nasal cannula continuous at night. (Side note: if patient uses a PAP machine it should read to be ported through PAP machine instead of via nasal cannula)

**Chart notes must be signed and dated by prescribing physician**

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Ordering Oxygen and Portables

• The patient must have a face to face visit (Not Telemedicine) with prescribing physician 

• The patient must have a prescription for the home concentrator AND portables

• The following information must be contained within the chart note:

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Patient has a respiratory diagnosis of (ex. COPD etc) Patient's oxygen saturation is _______(ex. 88%) on room air at rest. Alternative treatment measures have been tried and considered ineffective. Patient requires home oxygen concentrator at _____(ex 2 liters per minute, please ensure it matches liter flow on RX) liters per minute via nasal cannula with portable oxygen system. Patient is mobile within the home. 

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**SIDE NOTE: if patient is not 88 or less on room air to automatically qualify, THEN patient must ambulate on room air and have that saturation show a drop in their saturation, THEN ambulate with oxygen to show that the oxygen brings up their oxygen level. All three saturations must be included for those patients who do not automatically qualify.

**Chart notes must be signed and dated by prescribing physician**

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Ordering a Commode

• The patient must have a face to face visit (Not Telemedicine) 

• The patient must have a prescription

• One of the following must be contained within the chart note:

  • 1. The beneficiary is confined to a single room

  • 2. The beneficiary is confined to one level of the home environment and there is no toilet on that level

  • 3.The beneficiary is confined to the home and there are no toilet facilities in the home. 

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Ordering a Standard Wheelchair

• The patient must have a face to face visit (Not Telemedicine)

• The patient must have a prescription

• The following information should be within the chart note:

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Patient has a mobility limitation that requires a wheelchair in order for patient to complete ADLs within the home. Patient is able to self-propel a wheelchair. This mobility limitation cannot be resolved by use of a walker or cane. Patient will use wheelchair greater than two hours a day. 

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WHEELCHAIR ACCESSORIES- (add to chart notes as needed)

*ELEVATING LEG RESTS-elevating leg rests are needed for lower extremity edema

*SEATBELT- patient has weak body muscles or upper body instability

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Ordering a Hemi Wheelchair

• The patient must have a face to face visit (Not Telemedicine)

• The patient must have a prescription

• The following information should be within the chart note:

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Patient has a mobility limitation that requires a hemi wheelchair in order for patient to complete ADLs within the home. Patient requires a lower seat height due to short stature and to self-propel a wheelchair. This mobility limitation cannot be resolved by use of a walker or cane. Patient will use wheelchair greater than two hours a day and requires adjustable arm height for comfort. 

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WHEELCHAIR ACCESSORIES- (add to chart notes as needed)

*ELEVATING LEG RESTS-elevating leg rests are needed for lower extremity edema

*SEATBELT- patient has weak body muscles or upper body instability

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Ordering a Lightweight Wheelchair

• The patient must have a face to face visit (Not Telemedicine)

• The patient must have a prescription

• The following information should be within the chart note:

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Patient has a mobility limitation that requires a lightweight wheelchair in order for patient to complete ADLs within the home. Patient cannot self-propel in a standard wheelchair but can self-propel in a lightweight wheelchair. This mobility limitation cannot be resolved by use of a walker or cane. Patient will use wheelchair greater than two hours a day and requires adjustable arm height for comfort. 

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WHEELCHAIR ACCESSORIES- (add to chart notes as needed)

*ELEVATING LEG RESTS-elevating leg rests are needed for lower extremity edema

*SEATBELT- patient has weak body muscles or upper body instability

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Ordering a Heavy Duty Wheelchair

• The patient must have a face to face visit (Not Telemedicine)

• The patient must have a prescription

• The following information should be within the chart note:

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Patient weighs greater than 250 pounds and has a mobility limitation that requires a heavy duty wheelchair in order for patient to complete ADLs within the home. Patient is able to self-propel the wheelchair. This mobility limitation cannot be resolved by use of a walker or cane. Patient will use wheelchair greater than two hours a day and require adjustable arm height for comfort.

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WHEELCHAIR ACCESSORIES- (add to chart notes as needed)

*ELEVATING LEG RESTS-elevating leg rests are needed for lower extremity edema

*SEATBELT- patient has weak body muscles or upper body instability

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Ordering a Reclining Wheelchair

• The patient must have a face to face visit (Not Telemedicine)

• The patient must have a prescription

• The following information should be within the chart note:

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Patient has a mobility limitation that requires a reclining wheelchair in order for patient to complete ADLs within the home. Patient is at high risk for development of ulcers and is unable to perform functional weight shift. This mobility limitation cannot be resolved by use of a walker or cane. 

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OR

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Patient has a mobility limitation that requires a reclining wheelchair in order for patient to complete ADLs within the home. Patient uses intermittent catherization and cannot transfer from wheelchair to bed. This mobility limitation cannot be resolved by use of a walker or cane.

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WHEELCHAIR ACCESSORIES- (add to chart notes as needed)

*ELEVATING LEG RESTS-elevating leg rests are needed for lower extremity edema

*SEATBELT- patient has weak body muscles or upper body instability