Sunrise Medical K0005 dimensions Device K0031, ELR K0048

Quickie®2 K0005

2CUSHIONS AND BACKS

Specialty wheelchair backs and cushions, such as the Jay® 2 Back and Cushion, are covered items by Medicare with appropriate justification. Coding for all Jay products can be found on our website at: www.sunrisemedical.com.

3HEIGHT

ADJUSTABLE

ARMRESTS K0016

•Patient’s body dimensions cannot be accommodated by a standard height arm for functional positioning, weight shifts or lateral transfers.

•Adjustable height armrests are required for upper extremity support and postural stability.

4ANTI-TIPSK0021

•Anti-tips are required to prevent the wheelchair from falling over backwards during transfers.

•Anti-tips are required for safety to prevent the wheelchair from tipping over when encountering obstacles.

5WHEEL LOCKS

Anti-Rollback Devices

(Grade Aids)

K0080

•Upper extremity weakness, range of motion, balance, endurance and/or tonal anomalies require the use of an anti-rollback device for functional propulsion of a manual wheelchair on inclines and/or thresholds.

Wheel Lock Extensions

K0079

•Wheel lock extensions are needed due to the client’s weakness in their upper extremities.

•This feature will allow independent access to the wheel locks of the wheelchair.

•Upper extremity weakness,upper/ lower extremity range of motion, tonal anomalies, balance, vision/ perception and/or body dimension require the use of wheel lock extension for functional transfers and/or independent living activities.

Unilateral

K0108

•Can increase independence in performing transfers and ADLS while in the wheelchair by providing a client who has only one functioning upper extremity a means of securing the wheelchair.

CLINICAL BENEFITS

1Adjustable Axle Plate - K0005

• The adjustable axle allows the center of gravity of the wheelchair to be repositioned for maximum user independent maneuverability.

• The ability to create a “dump seat” with the adjustable axle plate and the adjustable caster housing provides a minimal fixed tilt that will assist in positioning, swallowing, breathing and head support.

• The adjustable rear axle plate allows for vertical and horizontal wheel changes, as well as camber options so the wheelchair can be adjusted to the users’ exact needs and abilities for maximizing the energy expended to self-propel the wheelchair.

• Upper extremity weakness, decreased range of motion, spasticity and/or poor endurance prevent the patient from functional propulsion of a high strength lightweight wheelchair with fixed or minimally adjustable axle plate.

• Poor balance, postural control and/or tonal anomalies require the ability to change seat angles which are a component of rear angle adjustment.

Note: Please be sure to provide a separate list of activities of daily living, including outside activities, and document why a lower level wheelchair will not meet the client’s needs.

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HANDRIMS6

Plastic Coated

K0059

Oblique

K0062/K0063

•Plastic coated/oblique handrims are medically necessary due to the beneficiary’s weakness in the hands and associated deficits in strength. This feature will facilitate independent propulsion of the wheelchair within their home environment.

•The client has decreased range of motion and weakness of the upper extremities. Plastic coated/ oblique handrims are required for improving the patient’s grip on the handrim, which improves stroke propulsion.

PELVIC7

POSITIONING

DEVICE - K0031

•A pelvic positioning belt is required to maintain the pelvis in neutral position due to upper extremity functional limitation; it will also increase client safety.

•A pelvic positioning belt is required to position the client’s hips at

the back of the wheelchair and to prevent sliding forward in wheelchair during mobility due to weakness within the trunk.

FOOT8

PLATES

Angle Adjustable

K0040

•Angle adjustable footplates are medically necessary due to lack of range of motion in the end user’s ankles.

•Angle adjustable footplates are necessary in order to permit angle adjustment of the feet to accommodate fixed deformities.

•To accommodate dorsior planar flexion of the ankles.

Heel Loops

K0034

•Heel loops are required to keep the lower extremities in an optimal position.

•To prevent foot/caster interference.

LEGREST/9

ELR - K0048

•Elevating legrests are required to position the lower extremities due to decreased flexion and to prevent further decrease

in range of motion.

•Patient has compromised circulation resulting in severe lower extremity edema, in which ELRs may be able to assist.