Article Detail - JD DME

Posted April 05, 2013

Question:

What date should be reported on the 7-element order for the face-to-face (F2F) examination for power mobility devices (PMDs)?

Response:

The required PMD F2F examination has two components. These components are:

1) Decision component - An in-person visit between the beneficiary and the ordering physician to document the decision to order a PMD; and,

2) Medical evaluation component - A medical examination to document the beneficiary's mobility and functional condition.

Both components are required and must be documented in the prescribing physician's records.

Several possible scenarios can affect the determination of the correct F2F examination date.

F2F Scenarios

•The ordering physician completes the entire F2F examination (both #1 & #2 above) during the initial, in-person encounter with the beneficiary. If this is the case, the date of the F2F examination is the date of that in-person encounter.

• The ordering physician has an initial in-person encounter with the beneficiary (#1 above) but does not complete the medical evaluation component (#2 above) of the F2F examination at this initial visit. At a subsequent visit with the ordering physician, the medical evaluation component is completed. In this situation, the date of the F2F examination is the date of the subsequent in-person encounter when the medical evaluation is completed.

• The ordering physician completes the decision component (#1 above) of the F2F examination at the initial in-person encounter with the beneficiary. The beneficiary is referred to another licensed clinical medical professional (LCMP) such as an Occupational Therapist (OT) or Physical Therapist (PT), who has experience and training in mobility evaluations, to perform all or a portion of the medical evaluation component (#2 above) of the F2F examination. The physician must indicate concurrence or any disagreement with the information in the written evaluation, sign and date the document. The F2F date listed on the 7-element order is the date the physician signed, dated and indicated concurrence or disagreement with the LCMP mobility evaluation.

• The ordering physician refers the beneficiary to an LCMP prior to the in-person encounter (#1 above) with the beneficiary. Once the physician has received and reviewed (stated concurrence, signed, and dated) the written report of the LCMP medical examination (#2 above), the physician must see the beneficiary and complete the decision component (#1 above). In this scenario, the date of the F2F examination reported on the 7-element order would be the date of the in-person encounter between the physician and beneficiary.

• The F2F examination is performed and completed during an inpatient hospital or nursing home stay, the date of the F2F examination reported on the 7-element order is either: 1) the date that both components 1 and 2 above are completed; or, 2) the date of discharge.

• The F2F examination has been completed, but the physician later identifies that there is information not properly documented in the medical record about the beneficiary which is necessary to support coverage criteria for a PMD. If the physician provides an amendment, correction or addenda to the F2F examination with information that arose from the previously performed F2F evaluation (both #1 & #2 above), the F2F examination date does not change on the 7-element order. The amendment, correction or addenda to the F2F evaluation should appear in the beneficiary's medical record.

• The F2F examination has been completed, but the physician later identifies that there is information that was not addressed during the F2F examination (both #1 & #2 above) which is necessary to support coverage criteria for a PMD. The physician must provide this new information in the medical record but since this was not a part of the original F2F, this does require a new in-person visit for the patient with the physician. This new F2F visit date becomes the F2F date on the 7-element order.

If the date of the F2F examination is entered incorrectly or if any other information on the 7-element order must be corrected, it is recommended the supplier request that the physician who completed the original 7-element order complete a new 7-element order. However, if a new 7-element order cannot be obtained, a corrected 7-element order is acceptable only when properly corrected/amended by the physician who originally signed it.

Any deletion and/or addition made to the 7-element order must be entered only by the physician who created the original 7-element-order, who must legibly sign and date the change.

In addition, a corrected 7-element order is acceptable only when the corrections/amendments are made prior to the completion of any detailed product description and prior to the date of service of the claim.

Suppliers are encouraged to review the Program Integrity Manual available on the Centers for Medicare & Medicaid Services Web site for additional information on amendments, corrections and delayed entries in medical documentation. This can be found in publication 100-08, chapter 3, section 3.3.2.5.

Additional information on how to change a 7-element order can be found in an article titled, "Changing a 7-Element-Order for a Power Mobility Device" available on the NHIC Web site. Suppliers can obtain additional information regarding medical necessity and documentation requirements for Power Mobility Devices in the Local Coverage Determination for Power Mobility Devices (L21271) and related policy article (A36239) which are also available on the NHIC Web site.

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