Dme Medical Billing Modifiers – All You Need To Know

By Author: Gracia Brown
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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.

Modifiers-a look.

Not all HCPCS code requires a modifier to be added but most of it comes along with a modifier. A modifier conveys whether the item is new, used, or rented on a capped basis, and when it comes to capped rentals, only modifiers show the difference of which month’s DME bill is being billed. Specifying these modifiers incorrectly can lead to rejection or denial of claims. Let us look at the commonly used modifiers in DME medicalbilling.

Common modifiers – RR for rental.

NU for purchase of new equipment.

UE for purchase of ...
... new equipment.

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 the initial claim and first-month rental.

KI- for second and third-capped rental.

KJ- from fourth to thirteenth capped rental months.

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.

XK 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.

• Orthopaedic 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 24/7 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 +1-888-502-0537.

Read More:https://www.247medicalbillingservices.com/dme-medical-billing-modifiers-all-you-need-to-know/