COLUMBIA, S.C.--TriCenturion, the Jurisdiction A/B DME program safeguard contractor, announced that it has started a widespread, pre-payment, probe review of the Group 2 standard captain's chair with patient weight capacity up to and including 300 pounds (HCPCS K0823). The review will be conducted in both Jurisdictions A and B.

In a bulletin issued last week, TriCenturion said data analysis was completed for dates of service Dec. 1, 2006, through March 31, 2007, on all new power wheelchair codes that went into effect on Nov. 15, 2006. The allowed amount for Group 2 power wheelchairs accounts for more than 90 percent of the total allowed amount for all new power wheelchair codes in each jurisdiction, the bulletin said.

More specifically, TriCenturion reported, the allowed amount for K0823 accounts for more than 77 percent of the allowed amount for Group 2 power wheelchairs in each jurisdiction.

"Widespread probe reviews are used to determine the extent of potential problem areas across multiple suppliers. TriCenturion believes a proactive approach to the increased provision of HCPCS K0823 will allow for identification of possible problems in the billing of this item," the notice said.

To evaluate compliance with Medicare coverage and coding rules and to identify contributing factors to the variance of expected treatment, the contractor said suppliers with K0823 claims billed to the Jurisdiction A or B DME MAC are subject to the review.

Suppliers whose claims are selected for review will receive an Additional Documentation Request letter asking for specific information to determine if the item billed complies with the existing reasonable and necessary criteria. If suppliers don't provide the requested information within 30 days, the claim will be denied.

Once the claims review has been completed, results will be analyzed and published in a PSC Medical Review article.

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