How To Use HCPCS Code E1085

HCPCS code E1085 describes a specific type of hemi-wheelchair with fixed full-length arms and swing-away detachable footrests. This code is used to identify the equipment used for enteral support that is not otherwise classified. It is important for medical coders to understand the meaning and usage of this code in order to accurately document and bill for the services provided.

1. What is HCPCS E1085?

HCPCS code E1085 is used to identify a hemi-wheelchair with fixed full-length arms and swing-away detachable footrests. This type of wheelchair is designed for individuals who have limited mobility on one side of their body. The fixed full-length arms provide stability and support, while the swing-away detachable footrests allow for easy transfer in and out of the wheelchair.

2. Official Description

The official description of HCPCS code E1085 is “Hemi-wheelchair, fixed full-length arms, swing away detachable footrests.” The short description is “Enteral supp not otherwise c.” This description accurately represents the specific features and purpose of this type of wheelchair.

3. Procedure

1. To use HCPCS code E1085, the healthcare provider must first assess the patient’s mobility needs and determine if a hemi-wheelchair is appropriate.
2. The provider will then measure the patient to ensure the wheelchair is the correct size and fit.
3. The hemi-wheelchair with fixed full-length arms and swing-away detachable footrests will be ordered and delivered to the patient.
4. The provider or a trained professional will instruct the patient on how to properly use and maneuver the wheelchair.
5. The patient will use the wheelchair as needed for mobility support.

4. When to use HCPCS code E1085

HCPCS code E1085 should be used when a patient requires a hemi-wheelchair with fixed full-length arms and swing-away detachable footrests for enteral support. This code is specifically for individuals who need this type of wheelchair but do not meet the criteria for any other specific HCPCS code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code E1085, healthcare providers must document the medical necessity of the hemi-wheelchair and provide supporting documentation, such as the patient’s medical records and any relevant diagnostic tests. The provider should also include a detailed description of the wheelchair, including the specific features of fixed full-length arms and swing-away detachable footrests.

6. Historical Information and Code Maintenance

HCPCS code E1085 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code E1085 is eligible for coverage under Medicare. The pricing indicator code 57 indicates that the service or supply is priced by other carriers. The multiple pricing indicator code A means that the code is not applicable as HCPCS priced under one methodology. Healthcare providers should consult the Medicare Carriers Manual Reference Section Number 2130 for specific guidelines and instructions on billing and reimbursement for this code.

8. Examples

Here are five examples of when HCPCS code E1085 should be billed:

1. A patient with limited mobility on one side of their body requires a hemi-wheelchair with fixed full-length arms and swing-away detachable footrests for enteral support.
2. An individual with a medical condition that affects their balance and coordination needs a hemi-wheelchair with specific features to assist with mobility.
3. A patient recovering from a stroke requires a hemi-wheelchair to aid in their rehabilitation and daily activities.
4. An elderly individual with arthritis in their lower extremities needs a hemi-wheelchair with fixed full-length arms and swing-away detachable footrests to alleviate pain and improve mobility.
5. A person with a physical disability that affects one side of their body requires a hemi-wheelchair with specific features to enhance their independence and quality of life.