Orthopedic Coding Alert

Question: Our office has an outside durable medical equipment (DME) supplier that bills the DME regional carrier (DMERC) directly for all braces, splints, etc. Is it possible for us to bill Medicare for applying these DME products using the CPT® codes even though we don’t bill Medicare directly for the durable medical goods?

Tennessee Subscriber

Answer: Many practices maintain similar arrangements with DME vendors that pay the medical practice fair-market-value rent to store an inventory of braces, orthotics, splints, etc., which the practice later dispenses to patients. Because most medical practices are not licensed DME suppliers, your practice cannot bill the DMERC directly for the supplies.

Although the DME vendor bills the patient’s insurance carrier for all items dispensed, you can certainly bill for applying these products. For instance, if you fit a patient for orthotics and train him to properly use the product, you may report 97760 (Orthotic[s] management and training [including assessment and fitting when not otherwise reported], upper extremity[s], lower extremity[s] and/or trunk, each 15 minutes).

According to the National Correct Coding Initiative (CCI), you can report 97760 in addition to an E/M code (99201-99215 for outpatient E/M visits). Documentation for 97760 must include the amount of time that the clinician spent fitting the orthotic and instructing the patient to use it.

Anytime your practice prescribes a DME product, remember to fill out a certificate of medical necessity (CMN) completely, or you risk having the patient’s claim for DME supplies denied.