How To Use HCPCS Code E1238

HCPCS code E1238 describes a pediatric size folding wheelchair that is adjustable and does not include a seating system. This code is used to identify the specific type of wheelchair being provided for pediatric patients. In this article, we will explore the details of HCPCS code E1238, including its official description, procedure, when to use it, billing guidelines, historical information, and Medicare and insurance coverage.

1. What is HCPCS E1238?

HCPCS code E1238 is used to identify a pediatric size folding wheelchair that is adjustable and does not include a seating system. This code is specific to the type of wheelchair being provided and is used for billing and documentation purposes.

2. Official Description

The official description of HCPCS code E1238 is “Wheelchair, pediatric size, folding, adjustable, without seating system.” The short description for this code is “Enteral supp not otherwise c.”

3. Procedure

1. Measure the patient to determine the appropriate pediatric size for the wheelchair.
2. Select a folding wheelchair that meets the adjustable specifications required for the patient.
3. Ensure that the wheelchair does not include a seating system.
4. Provide the wheelchair to the patient for use.

4. When to use HCPCS code E1238

HCPCS code E1238 should be used when providing a pediatric size folding wheelchair that is adjustable and does not include a seating system. This code is specific to this type of wheelchair and should not be used for other types of wheelchairs or equipment.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code E1238, healthcare providers should ensure that the documentation supports the medical necessity of the wheelchair for the pediatric patient. This may include documentation of the patient’s age, size, and specific needs that require the use of a folding wheelchair without a seating system. Providers should also follow any specific billing guidelines set forth by Medicare or other insurance carriers.

6. Historical Information and Code Maintenance

HCPCS code E1238 was added to the Healthcare Common Procedure Coding System on January 01, 1985. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important to note that this code has an effective date of January 01, 1996, and has been in use since then without any significant changes or updates.

7. Medicare and Insurance Coverage

HCPCS code E1238 is covered by Medicare and other insurance carriers. The pricing indicator code for this code is 57, which indicates that it is priced by other carriers. The multiple pricing indicator code is A, which means it is not applicable as HCPCS priced under one methodology. Providers should verify coverage and pricing with the specific insurance carrier to ensure proper reimbursement.

8. Examples

Here are five examples of when HCPCS code E1238 should be billed:

1. A 5-year-old patient with mobility limitations requires a folding wheelchair without a seating system for daily use.
2. A 3-year-old patient with a medical condition that affects their ability to walk independently needs a pediatric size folding wheelchair for occasional use.
3. A 7-year-old patient with a temporary injury that restricts their mobility requires a folding wheelchair without a seating system during the recovery period.
4. A 10-year-old patient with a chronic illness that affects their ability to walk long distances needs a pediatric size folding wheelchair for outdoor activities.
5. A 6-year-old patient with a physical disability requires a folding wheelchair without a seating system for school transportation.