Medical Billing Forum
Billing => Billing => : shelbylmk May 14, 2019, 06:21:48 PM
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Does anyone know of a website that I can ask DME billing questions too that is similar to this site? Please and thank you. :)
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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.
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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?
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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.
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So there wouldn't be any modifiers that I can use to separate them out then, correct?
Thank you for all your help.
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You had a claim for a piece of DME denied due to being in the 90 day global period?
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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.
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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?
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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.
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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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Thank you again for all your help.