Crutches, Refractive Lenses and other Supplies? Be Well-versed with Modifiers

You will need to be spot on with modifiers when it comes to crutches, refractive lenses and other supplies. Read on for more information on HCPCS medical codes and modifiers relating to these:

When a patient leaves your office with crutches, you report E0110 to your MAC. However you find denials waiting for you instead. Don't be surprised as this is a common issue that practices face when dispensing equipment. So get yourself up on collecting for equipment by getting to know two important modifiers.

Modifier NU

When you give out crutches, your work is cut out for you from a billing standpoint – unless you know the correct modifiers to add to your claim. Crutches will more likely need an NU modifier and the codes for lower leg DME need a modifier KX and an RT or LT modifier in Massachusetts for Medicare. You only use the KX modifier if the patient meets the criteria set up by Medicare for the DME. But the tricky part is that those criteria can change from one state carrier to the next; as such you need to be sure to get your MAC's policy in writing.

Steps to follow: Check if there is an LCD. If it's there and the criteria are met, then the claim will need the KX modifier. After this check the fee schedule for the code. If it's on the fee schedule and there's a modifier listed, the claim will need to be billed with that modifier.

Modifier position

The modifier listed on the fee schedule must be listed in the first position. As such the claim would be billed as E0110-NU-KX. As a quick reference for accurate billing, you can keep handy the DMEPOS HCPCS codes 2011 for your jurisdiction, as well as the LCD and fee schedules.

Remember: Always review the chart note for spot on coding and correctly add the right modifiers, the documentation in the patient's chart must always support the services and modifiers billed.

KX

It's likely that you find the KX modifier handy for more than just splints and crutches. Say for instance if you are providing refractive lenses for cataract surgery patients, you will need to use KX as your go-to modifier in order to tell the payer that your physician ordered the lenses.

For more information on HCPCS codes online , sign up for a good Medical coding resource like SuperCoder. Such a site provides you with HCPCS code lookup tools to assist you in your coding.

HCPCS Level II Codes G0440-G0441 Can be Used for Either Apligraf or Dermagraft

Two G codes - G0440-G0441 - to report your surgeon's work this year.

This year you can turn to two G codes - G0440, G0441 - when your surgeon applies a tissue-cultured skin or dermal substitute for Medicare patients with lower extremity ulcers owing to venous statis or diabetes. This is a welcome change from using the CPT codes for the service, which depend on the type of skin or dermal substitute as follows:

Apligraf -- 15340-+15341

Dermagraft -- 15360-+15361 or 15365-+15366
For most non-Medicare payers, you should continue to use the 15300-series codes.

Cause of concern: General surgeons, podiatrists, plastic surgeons and wound care specialists were worried that Apligraf had a 90-day global period in comparison to Dermagraft, which had a 30-day global period. This lead to a lot of confusion as it caused providers to use one product over another to get financial advantage. But with the new G codes around, not anymore.

Codes G0440-G0441 to the rescue: Codes G0440-G0441 can be used for either Apligraf or Dermagraft. These HCPCS medical codes ( Source "http://www.supercoder.com/hcpcs-codes/" )have a 0 global days and include the site preparation and debridement services.

The just-in codes together with a 0-day global billing period will do away with unequal financial incentives in the selection of products for the treatment of chronic wounds as well as help ensure that physicians make their treatment decisions based solely on clinical advantage.

The road ahead: The Centers for Medicare & Medicaid is working on valuing G0440 and G0441 this year to pave the way for CPT 2012 to offer category III codes to replace the temporary G codes.