Understanding DME Coding- HCPCS, Modifiers and ICD-10

DMEor durable medical equipment billing requires appropriate HCPCS (Healthcare Common Procedure Coding System) codes and modifiers. These are needed for describing the items that are being billed. For DME billing, ICD-10 diagnosis codes are also used, indicating the medical condition of the patient for which the equipment was prescribed.

  • In DME billing, coders need accurate HCPCS codes along with modifiers that are used for providing more information about the equipment. If the coders are failing to use modifiers or using them in an incorrect manner, then the claims may get denied. Some of the common modifiers include RR- rental, UE- purchase of used equipment and NU- purchase of new equipment.
  • When a lab requisition, request or referral for DME is being filled, coders will be needing ICD-10 codes for a patient’s diagnoses.

Intricacies of DME coding

  • DME coding intricacies can be quite challenging for coders. This is because DME codes are deeply rooted in HCPCS Level II codes and policies by Medicare. If the codes are not being assigned in the right manner, claims will get denied.
  • DMEPOS or durable medical equipment, prosthetics, orthotics and supplies are classified as HCPCS Level II codes that start with a letter and are followed by numbers. Whenever a coder is using HCPCS Level II codes, he/she needs to ensure that they are covered by Medicare.
  • When a coder uses HCPCS Level II code ending in 99, it is important to provide supporting documentation for billing that code.

HCPCS Code Range for DME

The HCPCS codes range DME E0100-E8002 is the standardised code set that is important for Medicare and health insurance providers to provide claims.

The 2019 HCPCS Level II code set includes nine new modifiers that will be helping DME billers and coders report services accurately that have been recently adopted or changed by Medicare.

Here are the new modifiers:

  • Modifiers CO and CQ
  • Modifier ER
  • Modifier G0
  • Modifier QA, QB and QR
  • Modifier QQ
  • Modifier VM

There have been certain 2019 changes to the Level II HCPCS codes as well, applicable to items that come under Medicare DME MAC jurisdiction. For instance, narrative changes to A9273 and E0218 for cold therapy, addition of B4105 for enteral nutrition and deletion of Q9994, narrative changes to E0483 for high frequency chest wall oscillation devices and J8655 for oral antiemetic drugs.

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