Imagine a situation when a patient leaves your office with crutches and you code E0110 to your MAC; however you find denials waiting for you in return. You're not alone. This is a common feature that practices come face to face with while giving out equipment which can lead to slowed claims and recurring denials. Two key modifiers can help your collections for equipments.
NU: When you look from a billing perspective, your work is cut out when you dispense crutches; unless of course you are well-versed with the proper modifiers to append your claim.
You can use the KX modifier if the patient meets the criteria set up by Medicare for the DME. However, the difficult part is that those criteria can change from one state carrier to another; as such it's essential that you have your MAC's policy in writing.
KX: Most probably you'll find the KX modifier handy for more than splints and crutches. Say for example if you are providing refractive lenses for cataract surgery patients, you will need to use KX as your go-to modifier in order to inform the payer that your physician ordered the lenses.
Medicare will shell out money for refractive lenses for aphakic beneficiaries. The payer covers one complete pair of glasses or contact lenses after each cataract surgery with insertion of an artificial intraocular lens.
The key to DME Medicare Administrative Contractor reimbursement for refractive lens features is medical necessity and this entails more than just selecting the right ICD-9 code.
The standard benefit is a flat-top (FT) 25/28 bifocal or trifocal in plastic or glass. A modifier will be important for the claim if the patient or the doctor calls for more features.
The prescribing physician must particularly order the special lens. It cannot be the patient's preference for one type of lens over another. So in case a physician specifically orders a particular type of lens or lens treatment, you need to append modifier KX to the HCPCS code.
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