Billing > Billing

DME Billing

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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.

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