Ophthalmology and Optometry Coding Alert

Question: I have always been billing DME (durable medical equipment) using modifier EY only on items that the patient requests. However, I noticed that Medicare has been rejecting my claims recently. My submissions have been dismissed because they were "unprocessable." What does this mean? Texas Subscriber Answer: Keep in mind that whenever you bill for DME, you have to make two claims; one for the items Medicare is paying and another for those that the patient has requested but Medicare won't pay. Do not put together ordered and non-ordered items on the same claim. Make a separate billing on ordered items. Claims containing a combination of ordered and nonordered items will be denied as unprocessable. CMS instituted modifier EY (No physician or other licensed health care provider order for this item or service) to allow DME suppliers to submit claims to Medicare for items without a prescription. The EY modifier [...]