Wiki Pneumatic Compression Devices - Outpatient Surgery

[intothewild12]

We are receiving bills for pneumatic compression devices/sleeves from DME suppliers (E0675 RR/E0673 NU or E0676 RR) with a POS 24 (Ambulatory Surgery Center).

Despite being used by the surgery center during operative procedures, these devices are being billed separately to patients by the DME suppliers.

Should these devices be considered part of the surgical package and/or surgical supplies and be billed by the surgical center? The DME provider sending a separate bill to patients appears to be unbundling to me.

Are there any citable sources that address this situation?

Thanks!!

 

[CBLENNIE]

We are receiving bills for pneumatic compression devices/sleeves from DME suppliers (E0675 RR/E0673 NU or E0676 RR) with a POS 24 (Ambulatory Surgery Center).

Who is the "we are receiving bills..." in your post? Are you with the ASC, a physician's office, or are asking on behalf of patients, which you mention as receiving separate bills for these services?

There is NCD 280.6 Pneumatic Compression Devices, which indicates the benefit category for these devices is DME. So then if you refer to the cross referenced NCD 280.1 which defines DME, you will find that billing for the use of these devices in an ASC would not be covered as DME and the charges for these devices should be inclusive of the equipment used to treat the patient while at the ASC.

NCD 280.1 Durable Medical Equipment Reference List shows the following information regarding what is defined as DME.

This is probably information that can help get you started on resolving the issue of patients being billed separately by the DME provider for these devices that were used post-operatively in an ASC and not in the patient's home.

 

[bunmidandy@yahoo.com]

Who is the "we are receiving bills..." in your post? Are you with the ASC, a physician's office, or are asking on behalf of patients, which you mention as receiving separate bills for these services?

There is NCD 280.6 Pneumatic Compression Devices, which indicates the benefit category for these devices is DME. So then if you refer to the cross referenced NCD 280.1 which defines DME, you will find that billing for the use of these devices in an ASC would not be covered as DME and the charges for these devices should be inclusive of the equipment used to treat the patient while at the ASC.

NCD 280.1 Durable Medical Equipment Reference List shows the following information regarding what is defined as DME.
View attachment 6722
This is probably information that can help get you started on resolving the issue of patients being billed separately by the DME provider for these devices that were used post-operatively in an ASC and not in the patient's home.

Hello, Thank you for your response. The new scheme is that some DME companies are billing for PCDs after patient's are discharged from an ASC.

 

[CBLENNIE]

Hello, Thank you for your response. The new scheme is that some DME companies are billing for PCDs after patient's are discharged from an ASC.

Are they billing the patient for use of the PCD at home after discharge from the ASC? Is there a physician order for the PCD and does the reason the device is being used meet the criteria in NCD 280.6 for PCDs in part states:



I'm not clear on what you are trying to explain as the "new scheme" is exactly. Are the patients being sent home with the PCD for use post-op for preventive reasons rather than for treatment of a covered condition as listed in the NCD?

 

[ambernic]

We are receiving bills for pneumatic compression devices/sleeves from DME suppliers (E0675 RR/E0673 NU or E0676 RR) with a POS 24 (Ambulatory Surgery Center).

Despite being used by the surgery center during operative procedures, these devices are being billed separately to patients by the DME suppliers.

Should these devices be considered part of the surgical package and/or surgical supplies and be billed by the surgical center? The DME provider sending a separate bill to patients appears to be unbundling to me.

Are there any citable sources that address this situation?

Thanks!!

Hi,
If we receive a claim for durable medical equipment with a place of service 24, we deny as included in the ambulatory surgery center rate. However, we received DME claims for pneumatic compression devices/sleeves regularly with a place of service of 12 (patient's home) and we allow it. We do look for doctor's orders or delivery receipt in the submitted documentation.