Common Modifiers for DME & All You Need to Know About it!

Durable medical equipment (DME) billing is a highly complicated process since it involves too many inclusions and a small detailing miss out may lead to rejection/denial of claims. In such additions, modifiers play an important role along with HCPCS codes according to the DME supplies. Modifiers provide the detailing/description of the DME item and decide the processing of claims raised on DME. Along with the HCPCS code, DME medical billing also includes an ICD-10 diagnosis code that determines the medical condition for which the item has been prescribed.
Have you ever identified the medical necessity for DME Durable Equipment items? How essential are modifiers when it comes to DME coding? Not so hard to answer, but very important to notice. Not all codes require modifiers, but few do not take the process forward without them. DME billing and coding are pretty different from other coding procedures as they involve patients’ Durable Medical Equipment. The entire billing and coding depend on it. This article provides you most commonly used HCPCS E codes and modifiers in DME coding. Let’s have a look.

Categories for using common modifiers:
  • Use modifiers RR, NU and UE for the following categories:
  • Capped rental item
  • Oxygen equipment without contents
  • Items that require frequent and substantial servicing
  • Routinely purchased items or inexpensive ones

When it comes to capped rentals, along with RR, the following modifiers should be added to determine the rental period:

  • KH- for initial claim and first-month rental
  • KI- for second and third-capped rental
  • KJ- from fourth to thirteenth capped rental months
Few HCPCS E Codes used in DME Coding:

First of all, before an item can be considered DME, it’s supposed to meet all of the following requirements:

  • The equipment must be able to withstand repeated use.
  • DME must be primarily and customarily used to serve a medical purpose.
  • It’s generally not considered for a person in the absence of an illness or injury.
  • It should also be appropriate to use it in the home.
Find all E codes that fall under the jurisdiction of the DME below:
  • E0100 – This code is used for cane and includes canes of all materials, adjustable or fixed, with tip.
  • E0105– This code is used for cane, quad, or three prongs and includes canes of all materials, adjustable or fixed, with tips.
  • E0110– This code is used for crutches, forearms, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips.
  • E0111– This code is used for crutch forearm includes crutches of various materials, adjustable or fixed, each, with tip and handgrips.
  • E0112– This code is used for crutches underarm, wood, adjustable or fixed, pair, with pads, tips, and handgrips.
  • E0113– This code is used for crutch underarm, wood, adjustable or fixed, each, with pad, tip, and handgrip.
  • E0114– This code is used for crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips, and handgrips.
  • E0116– This code is used for crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each.
  • E0117– This code is used for crutch, underarm, articulating, spring assisted, each.
  • E0118–This code is used for crutch substitute, lower leg platform, with or without wheels, each.
  • E0130 – This code is used for walker, rigid (pickup), adjustable or fixed height.
  • E0135–This code is used for walker, folding (pickup), adjustable or fixed height.
  • E0140 – This code is used for walker, with trunk support, adjustable or fixed height, any type.
  • E0141 – This code is used for walker, rigid, wheeled, adjustable, or fixed height.
  • E0143 – This code is used for walker, folding, wheeled, adjustable or fixed height.
  • E0144– This code is used for walker, enclosed, four-sided framed, rigid or folding, wheeled with a posterior seat.
  • E0147– This code is used for walker, heavy-duty, multiple braking systems, variable wheel resistance.
  • E0148– This code is used for walker, heavy-duty, without wheels, rigid or folding, any type, each.
  • E0149– This code is used for walker, heavy-duty, wheeled, rigid or folding, any type.
  • E0153– This code is used for platform attachment, forearm crutch, each.
  • E0154– This code is used for platform attachment, walker, each.
  • E0155– This code is used for wheel attachment, rigid pick-up walker, per pair.
  • E0156– This code is used for seat attachment, walker.
  • E0157– This code is used for crutch attachment, walker, each.
  • E0158– This code is used for leg extensions for walker, per set of four (4).
  • E0159– This code is used for brake attachment for wheeled walker, replacement, each.
  • E0160– This code is used for sitz type bath or equipment, portable, used with or without commode.
  • E0161– This code is used for sitz type bath or equipment, portable, used with or without commode, with faucet attachment/s.
  • E0162– This code is used for sitz bath chair.
  • E0163– This code is used for commode chair, mobile or stationary, with fixed arms.
Maintenance and servicing

MS is the modifier that is used for a 6-month maintenance and servicing fee for required parts and labor that are not covered under any warranty of the supplier or the manufacturer. Moreover, maintenance and service payments are made every six months only after the member initially owns the equipment.

Replacement and repair

RA is the DME code applicable for the replacement of a DME item due to loss, non-repairable damage, or theft. But this modifier should be used only for the first-month rental claim for a replacement item.
RB is again a modifier that is applicable on replacement of a part of DME concerning repairs if any.

KX modifier for documentation on file

The KX modifier represents the presence of required documentation is on file to support the medical necessity of the item. The KX modifier is allowed for the following categories:

  • Cervical traction unit
  • External infusion pumps
  • Hospital beds
  • Nebulizers
  • Crthopaedic footwear
  • Patient lifts
  • Pre-fabricated knee orthoses
  • Walkers
  • Wheelchair options or accessories
  • CPAP
  • Wheelchair seating
  • Commodes and more
Conclusion

So far the modifiers you have learned about are just a part of DME billing, and multiple modifiers need to be remembered and specified in the claim form. But practically your DME practice can’t do it with utmost determination, since it is not feasible to hire and train more DME billing professionals to your practice. Therefore, the need for an expert DME billing company like Wenour Medical Billing Services is required to ensure smooth workflow and cash flow at your practice. To talk to our DME billing expert, make a call to 908-357-1313.

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