Have you ever identified the medical necessity for DME Durable Equipment items? How essential are modifiers when it comes to DME coding? Not so hard to answer, but very important to notice. Not all codes require modifiers, but few do not take the process forward without them. DME billing and coding are pretty different from other coding procedures as they involve patients’ Durable Medical Equipment. The entire billing and coding depend on it. This article provides you most commonly used HCPCS E codes and modifiers in DME coding. Let’s have a look.
Few HCPCS E Codes used in DME Coding:
- First of all, before an item can be considered DME, it’s supposed to meet all of the following requirements:
- The equipment must be able to withstand repeated use.
- DME must be primarily and customarily used to serve a medical purpose.
- It’s generally not considered for a person in the absence of an illness or injury.
- It should also be appropriate to use it in the home.
Find all E codes that fall under the jurisdiction of the DME below:
- E0100 – This code is used for cane and includes canes of all materials, adjustable or fixed, with tip.
- E0105– This code is used for cane, quad, or three prongs and includes canes of all materials, adjustable or fixed, with tips.
- E0110– This code is used for crutches, forearms, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips.
- E0111– This code is used for crutch forearm includes crutches of various materials, adjustable or fixed, each, with tip and handgrips.
- E0112– This code is used for crutches underarm, wood, adjustable or fixed, pair, with pads, tips, and handgrips.
- E0113– This code is used for crutch underarm, wood, adjustable or fixed, each, with pad, tip, and handgrip.
- E0114– This code is used for crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips, and handgrips.
- E0116– This code is used for crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each.
- E0117– This code is used for crutch, underarm, articulating, spring assisted, each.
- E0118–This code is used for crutch substitute, lower leg platform, with or without wheels, each.
- E0130 – This code is used for walker, rigid (pickup), adjustable or fixed height.
- E0135–This code is used for walker, folding (pickup), adjustable or fixed height.
- E0140 – This code is used for walker, with trunk support, adjustable or fixed height, any type.
- E0141 – This code is used for walker, rigid, wheeled, adjustable, or fixed height.
- E0143 – This code is used for walker, folding, wheeled, adjustable or fixed height.
- E0144– This code is used for walker, enclosed, four-sided framed, rigid or folding, wheeled with a posterior seat.
- E0147– This code is used for walker, heavy-duty, multiple braking systems, variable wheel resistance.
- E0148– This code is used for walker, heavy-duty, without wheels, rigid or folding, any type, each.
- E0149– This code is used for walker, heavy-duty, wheeled, rigid or folding, any type.
- E0153– This code is used for platform attachment, forearm crutch, each.
- E0154– This code is used for platform attachment, walker, each.
- E0155– This code is used for wheel attachment, rigid pick-up walker, per pair.
- E0156– This code is used for seat attachment, walker.
- E0157– This code is used for crutch attachment, walker, each.
- E0158– This code is used for leg extensions for walker, per set of four (4).
- E0159– This code is used for brake attachment for wheeled walker, replacement, each.
- E0160– This code is used for sitz type bath or equipment, portable, used with or without commode.
- E0161– This code is used for sitz type bath or equipment, portable, used with or without commode, with faucet attachment/s.
- E0162– This code is used for sitz bath chair.
- E0163– This code is used for commode chair, mobile or stationary, with fixed arms.
Most Commonly used DME Modifiers in DME Coding:
- Before getting to know the modifiers, you will have to note few key points. They are:
- Ensure that you have identified the medical necessity for a DME Durable Equipment Item.
- Ensure whether you have documented the necessity.
- Make sure to have a delivery receipt that the patient had received the DME Item.
- Make sure that you report the correct DME Item.
- Ensure that you report the proper place of service.
- You will have to check with your insurance company how they want you to report the DME item on your claims.
Important Modifiers used:
- RR – RENTAL: Use this ‘R’ modifier when a DME is rented.
This particular modifier is used for DME items that are rented and are used for equipment for the following categories:
- Items that are Inexpensive or other Routinely Purchased DME (IRP)
- DME used for Frequent or Substantial Servicing (FS)
- Certain customized items are:
- Other Prosthetic and Orthotic Devices (P & O)
- Capped Rental Items (CR)
- Oxygen and Oxygen Equipment
- KH – DMEPOS item, initial claim, purchase, or first-month rental:
This modifier is used for a capped rental DME item. When using the KH modifier, you are indicating you are billing for the first month of the limited rental period. - KJ – DMEPOS item, Parenteral Enteral Nutrition (PEN) Pump or Capped- Rental, month four to fifteen:
This modifier is used for capped rental DME items. The KJ modifier is used for indicating and billing for months from four to thirteen/fifteen of the restricted rental period.
- KI – DMEPOS item, second or third month rental:
This modifier is used for capped rental DME items. When using the KI modifier, you are indicating you are billing for the second and third months of the restricted rental period. - A8 – Dressing for eight wounds:
Surgical dressing codes that are billed without modifiers A1-A9 are non-covered under the Surgical Dressings benefits. Certain dressings might be covered under other services. - A5 – Dressing for five wounds:
Surgical dressing codes that are billed without modifiers A1-A9 are non-covered under the Surgical Dressings benefits. Certain dressings might be covered under other services. - A4 – Dressing for four wounds:
Surgical dressing codes that are billed without modifiers A1-A9 are non-covered under the Surgical Dressings benefits. Certain dressings might be covered under other benefits. - A9 – Dressing for nine or more wounds:
Surgical dressing codes that are billed without modifiers A1-A9 are non-covered under the Surgical Dressings benefits. Certain dressings might be covered under other benefits.
- A1 – Dressing for one wound:
Surgical dressing codes billed without modifiers A1-A9 are non-covered under the Surgical Dressings benefits. Certain dressings might be covered under other benefits.
- A7 – Dressing for seven wounds:
Surgical dressing codes billed without modifiers A1-A9 are non-covered under the Surgical Dressings benefits. There are certain dressings that might be covered under other benefits. - A6 – Dressing for six wounds:
Surgical dressing codes billed without modifiers A1-A9 are non-covered under the Surgical Dressings benefits. Certain dressings might be covered under other benefits. - A3 – Dressing for three wounds:
Surgical dressing codes billed without modifiers A1-A9 are non-covered under the Surgical Dressings benefits. There are certain dressings that might be covered under other benefits.
- A2 – Dressing for two wounds:
Surgical dressing codes billed without modifiers A1-A9 are non-covered under the Surgical Dressings benefits. Certain dressings might be covered under other services.
There are numerous modifiers in the line used for different purposes in DME billing and DME coding. These remain very hard to remember and thus recommended to outsource DME coding and billing services. As it’s vital to know these modifiers and their use, healthcare professionals must learn more about them before using them.
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