DME Modifiers- Know more to get more!

Durable Medical Equipment (DME) like Crutches, canes, special cots, wheelchairs, slings, electrodes, etc are being frequently prescribed by physicians to help out people who have suffered injuries. However, there are several models and types available with a host of features. It is important that an injured person gets the correct equipment at an affordable price.

In order to streamline this, the Centers for Medicare and Medicaid Services (CMS) set up the Healthcare Common Procedure Coding Systems (HCPCS), and most of the manufacturers have, and service providers have their own catalogs that help patients identify and select what they need.

Understanding Modifiers

Modifiers are responsible for influencing fee schedules and play an important part in fixing the prices paid for durable medical equipment, which DME billing services should be aware of. The modifiers indicate whether the item in question comes under purchase, rental, or maintenance mode. (NU, RR, MS).

DME Medicare billing companies should know that the reimbursements for rental and purchase are not the same. There are a few states that allow alternate permissible amounts depending on some lesser-known modifiers based on certain technical and professional components. Durable medical equipment billing companies should make it a point to learn what each modifier means and when each one can be used appropriately.

Understand Unspecified and Miscellaneous Codes

Codes like E 1399 and A 9999 are miscellaneous and unspecified codes that are known to DME billing services providers as representing a “red flag” meaning the bill requires additional review. In spite of this, there are several other unspecified codes that go completely unnoticed and are subject to be abused or misused as there is no proper fee schedule to guide the durable medical equipment billing companies.

For instance, the code K0108 is for a component or accessory of a wheelchair, which is not clearly specified. The fact is that most of the components and accessories for wheelchairs carry specific codes that are appropriate. Yet another example is code A6459 which is for gradient compression stocking, which is again not specified. What is confusing here is that there are several compression codes specifying the gradient of pressure and the stocking length which a durable medical equipment billing company may not be aware of.

Take Stock of Bundled Codes and Customization

Most providers are under the impression that once the patient has been evaluated, the durable medical equipment item can be termed “custom” and justifies the miscellaneous code E 1399. However, this need not be the case at all times. DME billing services providers should realize that they can be held responsible and need to know how and when they can use such specific terms to ensure accurate billing. A power wheelchair with attachments like a basket or headlights may not be classified as “custom” and can only be termed a wheelchair with extra options.

The durable medical equipment billing company should use the appropriate HCPCS for the base and have the extra components billed under a separate heading. The best way to establish if any item is “custom” is to find out if it has been classified as such by the manufacturer. Several manufacturers do publish order forms that help identify the “custom” parts easily. DME billing services providers should make it a point to consult the resources and ensure that correct and cost-effective methods are adopted while billing.

Products that don’t come under HCPCS coding

There are several medications that are tagged with HCPCS codes and also specific national drug codes (NDC) that carry the brand name and details of the product. The same applies to durable medical equipment as well, though HCPCS need not be specific to any brand and may have many products that are classified under the same code.

As far as durable medical equipment is concerned it is simply relabeled and usually does not reflect the true value for a particular item. Identifying the product manufacturer helps to fix the appropriate price and avoids unnecessary mark-ups, the costs of which are borne by the users.

DME billing services providers need to realize that reviewing DME billing calls for expertise and paying attention to detail. There are several rules and virtually hundreds of codes to deal with, and whenever in doubt it makes sense for a durable medical equipment billing company to strictly follow CMS Regulations that can help review DME billing accurately and in a cost-effective manner.