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.
When it comes to capped rentals, along with RR, the following modifiers should be added to determine the rental period:
First of all, before an item can be considered DME, it’s supposed to meet all of the following requirements:
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.
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.
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:
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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