+ Home Oxygen

Requirements:

• SpO2 < 88% while at rest
• SpO2 < 88% with exertion (6-minute walk test)
• Needs documentation of titration of oxygen and LPM recs

Ordering:

• Does require Face-to-Face documentation of above requirements
• Print facesheet from visit
• Fill out Certificate of necessity
• Sample Lincare form - be sure to mark "care check" to allow company to recertify need for oxcygen at home. These are available in SW office
• Bring these to SW for help ordering and setting up with Home Oxygen Company

+ Brace

• Does not require Face-to-Face documentation
• Order in EPIC using preference panel
• Often available over the counter
• If prescribing, specify splint type and ICD-10 Code, for example:
  • M65.4 - Spica Thumb: Radial Styloid Tenosynovitis [de Quervain]
  • G56.00 - Neutral Wrist: Carpal Tunnel Syndrome
• PRINT prescription and give to patient to take to either their pharmacy or one of the DME-Pharmacies below

+ Wheelchair

• Requires Face-to-Face documentation
• Print facesheet from visit
• Be sure to put ICD-10, for example:
  • Z91.81 - History of falling
  • M62.81 - Muscle weakness (generalized)
  • R53.81 - Debility (other malaise)
  • M25.30 - Other instability, unspecified joint
• In comments place height, weight, BMI
• Fill out Certificate of Necessity
• Order in EPIC using preference panel
• Print order and fax to DME Pharmacy below of patient preference

+ Hospital Bed

Requirements:

• Document why patient cannot lay flat (i.e. CHF)
• Need for frequent or immediate changes in body position that patient cannot do themselves
• Use of pillow and wedges without success
• Patient's head needs to elevated > 30 degrees

Order:

• Requires Face-to-Face to document above requirements
• Order in EPIC using preference panel
• Be sure to put ICD-10, height, weight, BMI in comments
• Print facesheet from visit
• Print order and fax to DME Pharmacy below of patient preference

+ Hoyer/Lift Chair

Requirements:

• Patient is a fall risk
• Utilizes walker for safe ambulation
• Utilizes walker to stand from sitting position
• Great effort for patient to stand without assistance

Order:

• Requires Face-to-Face to document above requirements
• Order in EPIC using preference panel
• Be sure to put ICD-10, for example:
  • Z91.81 - History of falling
  • M62.81 - Muscle weakness (generalized)
  • R53.81 - Debility (other malaise)
  • M25.30 - Other instability, unspecified joint
• In comments place height, weight, BMI
• Print facesheet from visit
• Print order and fax to DME Pharmacy below of patient preference

+ Shower Chair/Grab Bars

• Does not require Face-to-Face documentation
• Order in EPIC using preference panel
• Also available online ($20-$50)
• Specify ICD-10 Code, for example:
  • M62.81 - Muscle weakness (generalized)
  • R53.81 - Debility (other malaise)
  • M25.30 - Other instability, unspecified joint
• PRINT prescription and give to patient to take to either their pharmacy or one of the DME-Pharmacies below

+ Cane/Walker

• Does not require Face-to-Face documentation
• Order in EPIC using preference panel
• Specify ICD-10 Code, for example:
  • M62.81 - Muscle weakness (generalized)
  • R53.81 - Debility (other malaise)
  • M25.30 - Other instability, unspecified joint
• PRINT prescription and give to patient to one of the DME-Pharmacies below

+ Diabetic Shoes

Best completed by podiatrist

Requirements:

• History of partial/complete amputation of foot
• Peripheral neuropathy w/ callus formation
• History of previous foot ulcers or pre-ulcersative callus
• Foot deformity
• Poor circulation

Order:

• Requires Face-to-Face to document above requirements
• Be sure to put ICD-10 for Diabetes with complications, for example:
  • E11.621 - Foot ulcer
  • E11.40 - Neuropathy
  • E11.610 - Charcot Foot
• In comments place: height, weight, BMI
• Print facesheet from visit
• Print order and fax to DME Pharmacy below of patient preference

+ Power Scooter

+ Nebulizer