Durable Medical Equipment (DME) Billing is different from the other medical billing and coding for the specialties. Unlike the other coders and billers who work on DME need specialized training to deal with different medical situations and equipment that require different types of modifiers as requested. DME billers need a specialized in-depth, specialized knowledge for different types of HCPCS Level 2 codes.
Let’s understand the procedures of coding that can be implemented to make the billing process more effective:
- ICD-9 codes are 3-5 digits in length and speak to the patient’s conclusion
- CPT restorative charging codes are in fact HCPCS Level I codes. They are 5 digits in length and speak to the methodology performed at the patient’s visit
- HCPCS codes are in fact HCPCS Level II codes. They incorporate the two numbers and letters and are likewise 5 digits in length. These codes speak to the majority of the provisions or gear utilized in the patient’s consideration.
All Durable Medical Equipment is arranged under HCPCS Level II. In that capacity, these are the main codes you will use as a DME biller or coder.
Durable equipment must be recommended by a restorative specialist, found therapeutically important, and afterward affirmed by the patient’s insurance agency. At exactly that point the hardware is given to the patients.
Along these lines, the strong medicinal hardware charging and coding processes are substantially more convoluted than ordinary charging and coding.
The DME charging and coding process includes 3 noteworthy Steps
- The patient must be seen by a specialist, who finds that some kind of tough restorative hardware is therapeutically essential for the patient’s consideration, or because of the patient’s determination. For instance, a tyke presents to a pediatrics practice with croup (irritation of the aviation routes). The specialist inspects the patient and verifies that the patient will require a nebulizer treatment to regulate a steroid inhalant. This should be managed like clockwork for the duration of the night or until the point when the side effects stop. For this situation, the specialist will verify that the patient needs a nebulizer to bring home with them, and will endorse one to the patient.
- After the patient sees the specialist and is recommended a bit of tough restorative gear, the patient will at that point go to a DME provider to get the provisions. What this implies for the coder is that you should find the supplier’s medicine and get the patient’s protection and charging data. On the off chance that important, because of the patient’s protection, you may likewise need to get a pre-approval. This is the place the insurance agency has inspected the patient’s conclusion and treatment, concurs with the discoveries, and supports the utilization of the DME supplies. When the majority of the essential printed material has been done, at that point the DME provider can find and disperse the right bit of hardware to the patient. On account of the nebulizer machine, the patient will give the DME provider their nebulizer machine remedy. The billers at the DME supply organization will do the majority of the important printed material, and furnish the patient with the right machine. This procedure works correspondingly to a drug solution.
- The last advance of the tough restorative hardware charging and coding process is doling out the right codes and charging the case to the patient’s insurance agency. This incorporates distinguishing the right HCPCS Level II codes by utilizing the HCPCS manual. This may sound simple, yet it’s vital to ensure that every single extra and bit of the gear is coded for. For instance, the DME provider won’t simply need to give the patient the nebulizer machine. They’ll additionally need to give the patient the air hose tubing and the right kind of face cover, contingent upon the patient’s age. Every one of the three of these things must be coded exclusively.
The DME biller should likewise send the case with any essential approval printed material, to ensure that the insurance agency will pay for the procedures.