REPAIRS / REPAIRS / BILLINGBILLING

By Peggy D. Walker, RNBy Peggy D. Walker, RNBilling & Reimbursement AdvisorBilling & Reimbursement AdvisorUS Rehab/VGM – 800-401-3643US Rehab/VGM – 800-401-3643

9/7/20119/7/2011V fax –877 907 3862V fax –877 907 3862

Mississippi AssociationMississippi Association10/4/201110/4/2011

When covered? When covered? • Repairs to equipment a beneficiary “owns” are covered when they are

necessary to make the equipment usable.

• The repair charge may include the use of loaner equipment when required.

• If the expense for repairs exceeds the estimated expense of purchasing or renting another item of equipment no payment can be made for the amount in excess.

• If claim is submitted for labor charge only, the claim should indicate the type of equipment being repaired.

• All repair claims must indicate that the pt. owns the equipment -name-make-model-when purchased & by whom---Block 19 for paper claim/narrative field elect. Can use code for base

• If you did not provide the original equipment you must have an order and documentation of continued need.

Coding Repairs for Coding Repairs for Patient Owned Patient Owned

equipmentequipment E1340/***K0739 ***effective 4/1/2009 is the code for labor (DME other

than Oxygen) – 1 unit equals 15 minutes. (Needs to be broken down and explained) ie: 15 minutes to replace arm rests; 30 minutes to change brakes and bearings etc.

K0462 – loaner equipment code while patient owned equipment is being repaired (paid up to one month rental) for any item not just w/cs

State what item is: (K0823 power chair rental while patient owned _____chair is being repaired) pt owned when purchased and by whom. Must be complete

K0740 is the repair code for Oxygen equipment

Billing & Billing & Modifiers Modifiers

***RP***DELETED***1/1/2009 --- E1340 deleted ***RP***DELETED***1/1/2009 --- E1340 deleted 4/1/20094/1/2009K0739 (4/1/09) would be first line with explanation of time units. (allowed amt 1 u $13.59 2011)

K0462 – second line with explanation of base (item) provided and what item is being repaired. {NO MODIFIER REQUIRED}

K0462 Does not have to be on same claim as repair “but” it is easier if it is.Use the code you are replacing with RB modifier for accessories and parts.KC modifier if replacing interfacesIf using K0108,E1399, E2399 state name, make, model and MSRP of item using. No modifiers

on these codes.NOTE – The new codes for power does not change the way you bill. You are not required to loan them the

same base they are in – just a base they can use while you repair theirs.When using the NOC codes make sure you state what the item is first ie: custom foot box by _____ model #

_______ MSRP _______KX modifier required for all w/c accessories 5/1/07 mwc/11/06 pwcsNOTE – Replacement for prosthetics/orthotics will follow the 5year DME rule exception for Breast

prosthesis only {these are 2 years or manf. warranty}!!! *** REPAIRS*** Part of Competitive Bid for items that are in the bid areas. New MODIFIERS -1-1-09 KE == RA == RB ***RP***DELETED***1/1/2009

Effective April 1, 2009, for supplies and accessories to be used with beneficiary-owned equipment, ALL of the following information must be submitted in Item 19 on the CMS-1500 claim form or in the NTE segment for electronic claims:

HCPCS code of base equipment; AND A notation that this equipment is beneficiary-owned; AND Date the patient obtained the equipment. NAME/MAKE/ & MODEL

K0462K0462Each claim submitted must include:Each claim submitted must include:

Information on Equipment being repairedInformation on Equipment being repaired Complete description (manf. model etc)Complete description (manf. model etc) Date purchased and by whom (can use base code)Date purchased and by whom (can use base code) Information on loaner equipment: (Can use base code)Information on loaner equipment: (Can use base code) Complete description /name/make/modelComplete description /name/make/model Description and time needed for repairsDescription and time needed for repairsIt is not required to be billed on same claim as repair but It is not required to be billed on same claim as repair but

works better if you doworks better if you do

Why repair took longer than one dayWhy repair took longer than one daySuggest that you use the DMEPDAC code for item loaned Suggest that you use the DMEPDAC code for item loaned

as well to make pricing simpler.as well to make pricing simpler.

MODIFIERS MODIFIERS KX modifier is required on accessories KX modifier is required on accessories K0462 does not require any modifierK0462 does not require any modifier RA (effective date 1-1-09) is the replacement of the DME RA (effective date 1-1-09) is the replacement of the DME

item itself (entire item is being replaced)item itself (entire item is being replaced) RB (1/1/09)Replacement of a part of DME furnished as RB (1/1/09)Replacement of a part of DME furnished as

part of a repairpart of a repair E0739 (4/1/09) does not require any modifiers but does E0739 (4/1/09) does not require any modifiers but does

require a break out of unit needs.require a break out of unit needs. ** RP** deleted as of 1/1/09 {E1340 deleted 4/1/09}** RP** deleted as of 1/1/09 {E1340 deleted 4/1/09} Use K0739 for labor on/after 4/1/09Use K0739 for labor on/after 4/1/09 DO NOT FORGET the KE modifier on any part or accessory DO NOT FORGET the KE modifier on any part or accessory

that could be part of round 1 CB base itemthat could be part of round 1 CB base item NO KE required on bases still use on Manual w/c accessoriesNO KE required on bases still use on Manual w/c accessories KK is replacement modifier for CBAs – for accessories on KK is replacement modifier for CBAs – for accessories on

complex rehab bases that could be provided on group 2 CB complex rehab bases that could be provided on group 2 CB itemsitems

IN CBAs parts will be paid at the CB price (CAUTION) you do IN CBAs parts will be paid at the CB price (CAUTION) you do not want to go there – REMEMBER pts. in CB area can’t do not want to go there – REMEMBER pts. in CB area can’t do non assigned. non assigned.

Repair QuestionnaireRepair QuestionnairePatient Name:Patient Name:Medicare No. Medicare No. Address:Address:

Name, Make & Model of the item that is being repaired: Name, Make & Model of the item that is being repaired: ________________________________

Serial number of item being repaired: ________________ Serial number of item being repaired: ________________ Date wheelchair (item) was provided: __________________Date wheelchair (item) was provided: __________________How was wheelchair (item) funded? (pay or source) ______________ How was wheelchair (item) funded? (pay or source) ______________

Loaner chair given? Name Loaner chair given? Name ____________ Make ________ Model ________ Make ________ Model ________(----- code as well – for pricing information for K0462)(----- code as well – for pricing information for K0462)If funded by Medicare was chair (item) purchased or rented? If funded by Medicare was chair (item) purchased or rented?

________ ________

If the wheelchair (item) was provided by a company other than If the wheelchair (item) was provided by a company other than ____________________________ the information above must be ____________________________ the information above must be confirmed by the supplier ( if the supplier is unknown to the confirmed by the supplier ( if the supplier is unknown to the patient or out of business check per the VRU at Medicare for patient or out of business check per the VRU at Medicare for order date. order date.

Confirmed by: _______________(employee) Date: __ __ ____Confirmed by: _______________(employee) Date: __ __ ____*** NEED justification of continued need .****** NEED justification of continued need .***

MCM replacement policyMCM replacement policy

If the item of equipment has been in If the item of equipment has been in “continuous” use by the patient on either a “continuous” use by the patient on either a rental or purchase basis for the equipment’s rental or purchase basis for the equipment’s useful lifetime, the “beneficiary” may “elect” to useful lifetime, the “beneficiary” may “elect” to obtain a new piece of equipment. Replacement obtain a new piece of equipment. Replacement may be reimbursed when a new physician order may be reimbursed when a new physician order and/or CMN, when required, is needed to and/or CMN, when required, is needed to reaffirm the medical necessity of the item.reaffirm the medical necessity of the item.

……useful lifetime is determined through useful lifetime is determined through program instructions. In the absence of program instructions. In the absence of program instructions the “carriers” may program instructions the “carriers” may determine the reasonable useful lifetime but at determine the reasonable useful lifetime but at no time can it be “less than” 5 years.no time can it be “less than” 5 years.

KE Modifier ListKE Modifier List

Standard Power AccessoriesStandard Power Accessories E0950 through E0957, E0960, E0973, E0978, E0981, E0982, E0990, E0995, E1016, E1020, E1028, E0950 through E0957, E0960, E0973, E0978, E0981, E0982, E0990, E0995, E1016, E1020, E1028, E2208, E2209, E2210, E2361, E2363, E2365 through E2371, E2381 through E2392, E2394, E2395, E2208, E2209, E2210, E2361, E2363, E2365 through E2371, E2381 through E2392, E2394, E2395, E2396, E2601 through E2608, E2611 through E2616, E2619, E2620, E2621, K0015, K0017 through E2396, E2601 through E2608, E2611 through E2616, E2619, E2620, E2621, K0015, K0017 through K0020, K0037 through K0047, K0050 through K0053, K0098, K0195, K0733 through K0737, K0020, K0037 through K0047, K0050 through K0053, K0098, K0195, K0733 through K0737,

Complex Rehabilitative Only AccessoriesComplex Rehabilitative Only AccessoriesE1002 through E1008, E1010, E1029, E1030, E2310, E2311, E2321 through E2330, E2351, E2373 E1002 through E1008, E1010, E1029, E1030, E2310, E2311, E2321 through E2330, E2351, E2373 KC*, E2374 through E2377KC*, E2374 through E2377(* When E2373 is used as a replacement only on a competitively bid complex rehabilitative product (* When E2373 is used as a replacement only on a competitively bid complex rehabilitative product (K0835 – K0864), use the KC modifier but not the KE modifier. When used as a replacement only on (K0835 – K0864), use the KC modifier but not the KE modifier. When used as a replacement only on a non-competitively bid manual or miscellaneous wheelchair, use the KE modifier, but not the KC a non-competitively bid manual or miscellaneous wheelchair, use the KE modifier, but not the KC modifier.)modifier.)

The KE modifier should also be used for tips (A4637) and hand grips (A4636) when used on a non-The KE modifier should also be used for tips (A4637) and hand grips (A4636) when used on a non-competitively bid cane or crutch, but not when used for a competitively bid walker (E0130, E0135, competitively bid cane or crutch, but not when used for a competitively bid walker (E0130, E0135, E1040, E0141, E0143, E0144, E0147, E1048 or E0149).E1040, E0141, E0143, E0144, E0147, E1048 or E0149).

The disposable canister code (A7000) requires the KE modifier when used with respiratory or gastric The disposable canister code (A7000) requires the KE modifier when used with respiratory or gastric suction pumps, but not when used for a competitively bid negative pressure wound therapy (NPWT) suction pumps, but not when used for a competitively bid negative pressure wound therapy (NPWT) pump (E2402). pump (E2402).

When providing an IV pole (E0776) with non-competitively bid parenteral nutrient codes, use the KE When providing an IV pole (E0776) with non-competitively bid parenteral nutrient codes, use the KE modifier, but not the BA modifier. When providing the IV pole for competitively bid enteral nutrient modifier, but not the BA modifier. When providing the IV pole for competitively bid enteral nutrient codes (B4149, B4150 and B4152 through B4155) use the BA modifier, but not the KE modifier.codes (B4149, B4150 and B4152 through B4155) use the BA modifier, but not the KE modifier.

KE Modifier example KE Modifier example billingbilling

January 1, 2009 the KE modifier was added to show that an January 1, 2009 the KE modifier was added to show that an item/accessory billed is being used on a non competitive item/accessory billed is being used on a non competitive bid item so that the allowable will not be decreased 9.5%bid item so that the allowable will not be decreased 9.5%

When billing for two units that requires the RT and LT When billing for two units that requires the RT and LT modifier use:modifier use:

E0973NUKERT99 then in narrative field put the LT and KX E0973NUKERT99 then in narrative field put the LT and KX modifiers.modifiers.

NU for new – KE for non CB item-RT for right -99 NU for new – KE for non CB item-RT for right -99 (>4modifiers required) LT (left) KX (doc. on file for Medical (>4modifiers required) LT (left) KX (doc. on file for Medical necessitynecessity

Type of Type of

EquipmentEquipmentPart Being Part Being

Repaired/ReplacedRepaired/ReplacedAllowed Units of Allowed Units of

Service (UOS)Service (UOS)

Power WheelchairPower Wheelchair Batteries (includes Batteries (includes

cleaning and testing)cleaning and testing)22

Power WheelchairPower Wheelchair Joystick (includes Joystick (includes

programming) programming) 22

Power WheelchairPower Wheelchair ChargerCharger 22

Power WheelchairPower Wheelchair Drive wheel motors Drive wheel motors

(single/pair)(single/pair)2/32/3

Power or Manual Power or Manual

WheelchairWheelchairWheel/Tire (all types, Wheel/Tire (all types,

per wheel)per wheel)11

Power or Manual Power or Manual

WheelchairWheelchairArmrest or armpadArmrest or armpad 11

Power WheelchairPower Wheelchair Shroud/cowlingShroud/cowling 22

Manual Wheelchair Manual Wheelchair Anti-tipping deviceAnti-tipping device 11

Hospital BedHospital Bed PendantPendant 22

Hospital BedHospital Bed Headboard/footboardHeadboard/footboard 22

CPAPCPAP Blower AssemblyBlower Assembly 22

Seat Lift Seat Lift Hand ControlHand Control 22

Seat LiftSeat Lift Scissor mechanismScissor mechanism 33

Patient Lift Patient Lift Hydraulic PumpHydraulic Pump 22

REPAIR AUDITS REPAIR AUDITS 2010/20112010/2011 Asking for face to face for powerAsking for face to face for power

Asking for proof of continued Medical Asking for proof of continued Medical necessity for all items ** IMPORTANT IF necessity for all items ** IMPORTANT IF YOU DID NOT PROVIDE THE EQUIPMENT**YOU DID NOT PROVIDE THE EQUIPMENT**

Look back period past 6 monthsLook back period past 6 months What this means is that you need to make What this means is that you need to make

sure the item you are providing has sure the item you are providing has documentation of continued need within the documentation of continued need within the past 6 months.past 6 months.

If no original face to face for power it is If no original face to face for power it is best to make sure you have one. best to make sure you have one.

This is resulting in need for ABNs and lots This is resulting in need for ABNs and lots of non-assigned claimsof non-assigned claims