Primary Care Coding Alert

Prescribing crutches or other supplies? Get sharp on modifiers.

When a patient leaves your office with crutches, your automatic response might be to report an appropriate HCPCS code, such as E0110 (Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips). If you get denials from your DME (durable medical equipment) MAC in return, get a leg up on collecting for equipment by getting to know two important modifiers.

Don't Overlook Modifier NU

When you report DME, you might be better off by turning to some less-used modifiers.

"Crutches will more than likely need an NU modifier (New equipment), and the codes for lower leg DME require a modifier KX (Requirements specified in the medical policy have been met) and an RT (Right side) or LT (Left side) modifier in Massachusetts for Medicare," says Rebekah Constant, CPC, coding and billing associate with Hawthorn Medical Associates, LLC, in North Dartmouth, Mass. "You only use the KX modifier if the patient meets the criteria set up by Medicare for the DME," Constant adds.

Resources: CMS and many private payers have specific guidelines for reporting modifier KZ. Check your local policies and CMS resources such s MLN Matters articles SE0826, SE0637, and MM5871 for more details.

The tricky part? Those criteria can change from one state to the next, so be sure to get your DME MAC's policy in writing.

Key: Payers might offer suggestions on steps to follow when submitting claims for DME. For example, Noridian advised Dawn Silva with Marin Medical Practice Concepts, Inc. in California, to follow these steps:

• Check whether there is an LCD. "If there is an LCD and the criteria are met, then the claim will require the KX modifier," Silva says.
• Check the fee schedule for the code. "If it is on the fee schedule and there is a modifier listed, the claim will need to be billed with that modifier.

Consider modifier position: The modifier listed on the fee schedule must be listed in the first position, Silva says. So for example, the claim would be billed as: E0110-NU-KX.

"As a quick reference for accurate billing, I keep handy the DMEPOS HCPCS codes 2011 for my jurisdiction, as well as the LCD and fee schedules," Silva advises. "Please always review the chart note for accurate coding and to accurately append the correct modifiers, the documentation in the patient's chart must always support the services and modifiers billed."