DME Billing

[shelbylmk]

Does anyone know of a website that I can ask DME billing questions too that is similar to this site? Please and thank you.

[kristin]

What sort of DME billing? I do a lot of it at my job, for certain items, maybe I could help.

Unfortunately, I don't know of a DME specific forum.

[shelbylmk]

I am wanting to get more info on how to code certain situations with modifiers. For example, I had a claim that denied because of the 90 day global period due to a surgical procedure. I was told by an insurance customer service rep that a modifier could be added to the claim to show that it was a separate item/procedure from the original procedure. I did speak with my supervisor and we decided to add a modifier 59 but I think that there could be a better modifier that would apply. Does anyone have any ideas?

[kristin]

Well, if you are trying to bill a separate procedure unrelated to the original procedure within a 90 day global, the new procedure gets a 79 modifier. This would not apply to DME items, though. Just to procedures.

The 59 modifier is ONLY for procedures done at the same time/session, to indicate they were separate from each other.

[shelbylmk]

So there wouldn't be any modifiers that I can use to separate them out then, correct?

Thank you for all your help.

[Michele]

You had a claim for a piece of DME denied due to being in the 90 day global period?

[shelbylmk]

Sorry for the late reply. Yes I did have a DME claim deny due to being in the 90 day global period but the surgery date and the date that patient received the brace were two different days.

[Michele]

If the equipment is related to the surgery then it may be that they consider it as something that should be provided with the surgery, is that possible?

[shelbylmk]

There is a possibility of that but since they didn't get until 2 days later I thought I would triple check to make sure that it couldn't be billed as a separate charge from the surgery. I was told by the insurance company that there could be a modifier that I could add to the claim to make a separate charge and get paid for it separately. I did try the modifiers 59 and 25 but those aren't correct. So, I wanted to get an opinion on the situation. I was thinking of using modifier 24 or 79 on the claim. What does everyone think? Thank you for the help.

[Michele]

If the equipment is not related to the surgery then the 79 modifier might be appropriate.  The 24 is for E&M services so that wouldn't be appropriate.  Be careful not to just "throw" a modifier on there trying to get it paid.  You need to make sure the modifier fits the circumstances and the services.  Both 24 & 25 are for E&M services so those should not be used for DME.

[shelbylmk]

Thank you again for all your help.