Get well-versed with modifiers NU, KX.
After a patient goes out from your office with crutches,
your spontaneous response then might be to report a suitable HCPCS code, after
thorough HCPCS code search , for instance E0110 (Crutches, forearm, includes
crutches of various materials, adjustable or fixed, pair, complete with tips
and handgrips). In case you in turn receive denials from your DME (durable
medical equipment) MAC, treat this as an opportunity on collection for
equipment by getting well-versed with two important modifiers.
Don't Overlook Modifier NU
Once you report DME, you might be at an advantage by turning
to some less-used modifiers.
Crutches will more than likely necessitate an NU modifier
(New equipment), and the codes for lower leg DME would necessitate a modifier
KX (Requirements specified in the medical policy have been met) along with an
RT (Right side) or LT (Left side) modifier. You merely use the KX modifier in
case the patient meets the criteria as established by Medicare for the DME.
Resources: CMS along with a lot of private payers have
detailed guidelines meant for reporting modifier KZ. You must check your local
policies and CMS resources .
The complex part? Those criteria can vary from one state to
the other one, so make certain that you get your DME MAC's policy in writing.
Key: Payers might provide recommendations on steps to follow
when submitting claims for DME and for accurate HCPCS code search. For
instance:
You must always check whether there is an LCD. In case there
is an LCD and the required criteria are met, then the claim will necessitate
the KX modifier
You must always check the fee schedule for the code. In case
it is on the fee schedule and there is a modifier listed, the claim will be
required to be billed with that modifier. In the instance of billing crutches
(E0110), this code is listed three times with these modifiers - NU, RR (Rental)
as well as UE (Used durable medical equipment). Consequently, you must always
select the appropriate modifier for billing.
Consider modifier position: The modifier that is listed on
the fee schedule should be listed in the first position. So for instance, the
claim would be billed as: E0110-NU-KX.
As a quick reference for correct billing and for accurate
HCPCS code search, you must keep DMEPOS HCPCS codes 2011 at your fingertips for
your control, along with the LCD and fee schedules. You must always review the
chart note for precise coding and to accurately append the correct modifiers,
the documentation in the patient's chart should at all times support the
services along with modifiers billed.
