What your doctor needs to write down

To the treating practitioner: your patient is being referred to Choice Healthcare for durable medical equipment. Medicare and most plans require specific findings in the chart before the item can be approved. The items below are the ones that most often decide whether this is covered. We'll prepare the order and the prior authorization — we just need these in your note.

• The qualifying diagnosis, with ICD-10 code
• The functional limitation — not just the diagnosis, but what the patient cannot do
• How that limitation impairs activities of daily living inside the home: toileting, bathing, dressing, grooming, feeding
• Why a lesser device is not sufficient (why a cane won't do, why a walker won't do, why a manual chair won't do)
• That the visit's date is within the required window, and for mobility, that mobility was a major reason for the visit
• Your signature, date, printed name and NPI

• A mobility evaluation with the chief complaint of mobility limitation
• The specific device prescribed — power wheelchair, scooter, custom manual chair
• Physical examination findings: strength, range of motion, endurance, transfers, sitting tolerance
• A recent, in-person height and weight
• Whether the patient can safely operate the device, or has a caregiver who can assist
• A referral for PT/OT evaluation if the device requires one

• The wound type, location, and for pressure injuries, the stage
• Measurements — length, width and depth — and how long the wound has been present
• Drainage amount, tissue type, and signs of infection
• What has already been tried: dressings, debridement, offloading, compression, nutrition
• For negative pressure therapy, why a standard wound-care program was not enough
• The specific products and quantities being ordered

• Certification that the patient has diabetes and is being treated under a comprehensive plan of care for it — this must be the physician managing the diabetes
• At least one qualifying foot condition: previous amputation, prior ulceration, pre-ulcerative callus, neuropathy with callus formation, foot deformity, or poor circulation
• A diabetes-management visit note dated within six months of delivery
• A foot examination within six months — and if someone else performed it, your review, initials and date

• Insurance cards — all of them
• Photo ID
• A list of current medications
• The name and phone of your ordering doctor
• Contact details for a caregiver, if you have one
• This sheet