Hospital Beds and Accessories—Physician Documentation

The CMN requirement for hospital beds and accessories was removed as of January 1, 2007. This change places more emphasis on the need for well documented medical necessity information to ensure Medicare coverage in regards to a hospital beds and/or accessories. Suppliers are reliant upon the physician community to provide detailed documentation to support medical necessity.

The following information is to assist the physician community regarding documentation requirements the Jurisdiction B DME MAC. The DME MAC may request additional information from the supplier, the ordering physician or the beneficiary through the ADR.

The physician’s detailed written order must be obtained prior to a supplier billing Medicare. The detailed written order must include all of the following:

• the beneficiary’s name and full address
• a detailed description of the item
• the signature of the treating physician, and
• the date the order was signed

The physician’s progress notes are an integral part of the patient’s medical records and may be requested in order to prove medical necessity has been met. The physician’s progress notes should be in their typical format, documenting the medical necessity in regards to the need for a hospital bed. There should be information regarding the patient’s history, diagnosis, mobility functions and limitations, prognosis, and any information to support a medical condition which requires positioning of the body in ways not feasible with an ordinary bed. Please keep in mind that the need of elevation less than 30 degrees does not usually require the use of a hospital bed.

Documentation should indicate any previous methods tried prior to the use of a hospital bed such as the use of pillows or wedges being considered and ruled out.

Beds

The various bed types must meet specific qualifications once the basic coverage criteria have been met.

1. Variable height hospital bed documentation must indicate the need to adjust the bed height to enable the patient to transfer to chair, wheelchair, or standing position versus a fixed height bed.
2. Semi - electric hospital bed documentation must indicate the need for frequent changes in body position and/or has an immediate need for a change in body position. This would be positioning in regards to the feet or head elevation.
3. Heavy duty or extra heavy duty hospital bed documentation must indicate the patient’s weight to meet coverage criteria for one of these beds.

Accessories

In order to meet coverage for an accessory the patient must have documentation to support the need for a hospital bed. If they have met the criteria for a hospital bed then documentation must support the need for the accessories.

1. Trapeze equipment the documentation must indicate a need to use a trapeze device in order to sit up due to a respiratory condition, to change body position for other medical reasons, or to get in or out of bed. The patient’s weight must be documented in order to meet criteria for a heavy duty trapeze.
2. Bed cradle documentation must indicate a need to prevent contact with the patient’s bed coverings.
3. Side rails or safety enclosures documentation must support the need to prevent the patient from leaving the bed or to prevent fall risks associated with the patient’s history.

It is important that the patient’s medical record support the need for the items to be covered by Medicare. For more information regarding Medicare coverage please refer to the hospital beds and accessories local coverage determination on the National Government Services Web site.