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 decides the processing of claims raised on DME. Along with HCPCS code, DME medical billing also includes an ICD-10 diagnosis code that determines the medical condition for which the item has been prescribed.
Not all HCPCS code requires a modifier to be added but most of it comes along with a modifier. Basically, 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 medical billing.
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 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 labour 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 with respect to repairs if any.
KX 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
- Orthopaedic footwear
- Patient lifts
- Pre-fabricated knee orthoses
- Wheelchair options or accessories
- Wheelchair seating
- Commodes and more
So far the modifiers you have learned about is just a part of DME billing, and there are multiple modifiers that need to be remembered and specified in the claim form. But practically it is not possible for your DME practice to 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.