Repairs

							REPAIRS / BILLING


       By Peggy D. Walker, RN
  Billing & Reimbursement Advisor
   US Rehab/VGM – 800-401-3643
                9/7/2011
          V fax –877 907 3862
         Mississippi Association
               10/4/2011
                       When covered?
•   Repairs to equipment a beneficiary “owns” are covered when they are
    necessary to make the equipment usable.

•   The repair charge may include the use of loaner equipment when
    required.

•   If the expense for repairs exceeds the estimated expense of purchasing
    or renting another item of equipment no payment can be made for the
    amount in excess.

•   If claim is submitted for labor charge only, the claim should indicate the
    type of equipment being repaired.

•   All repair claims must indicate that the pt. owns the equipment -name-
    make-model-when purchased & by whom---Block 19 for paper
    claim/narrative field elect. Can use code for base

•   If you did not provide the original equipment you must have an order and
    documentation of continued need.
           Coding Repairs for Patient
             Owned equipment
   E1340/***K0739 ***effective 4/1/2009 is the code for labor (DME other
    than Oxygen) – 1 unit equals 15 minutes. (Needs to be broken down
    and explained) ie: 15 minutes to replace arm rests; 30 minutes to
    change brakes and bearings etc.

   K0462 – loaner equipment code while patient owned equipment is
    being repaired (paid up to one month rental) for any item not just w/cs

   State what item is: (K0823 power chair rental while patient owned
    _____chair is being repaired) pt owned when purchased and by
    whom. Must be complete

   K0740 is the repair code for Oxygen equipment
                        Billing & Modifiers
                  ***RP***DELETED***1/1/2009 --- E1340 deleted 4/1/2009
K0739 (4/1/09) would be first line with explanation of time units. (allowed amt 1 u $13.59 2011)
K0462 – second line with explanation of base (item) provided and what item is being repaired.
            {NO MODIFIER REQUIRED}
K0462 Does not have to be on same claim as repair “but” it is easier if it is.
Use the code you are replacing with RB modifier for accessories and parts.
KC modifier if replacing interfaces
If using K0108,E1399, E2399 state name, make, model and MSRP of item using. No modifiers
            on these codes.
NOTE – The new codes for power does not change the way you bill. You are not required to loan them the
            same base they are in – just a base they can use while you repair theirs.
When using the NOC codes make sure you state what the item is first ie: custom foot box by _____ model
            # _______ MSRP _______
KX modifier required for all w/c accessories 5/1/07 mwc/11/06 pwcs
NOTE – Replacement for prosthetics/orthotics will follow the 5year DME rule exception for Breast
            prosthesis only {these are 2 years or manf. warranty}!!!
*** REPAIRS*** Part of Competitive Bid for items that are in the bid areas.
 New MODIFIERS -1-1-09 KE == RA == RB ***RP***DELETED***1/1/2009
Effective April 1, 2009, for supplies and accessories to be used with beneficiary-owned equipment, ALL of
            the following information must be submitted in Item 19 on the CMS-1500 claim form or in the
            NTE segment for electronic claims:
    HCPCS code of base equipment; AND
    A notation that this equipment is beneficiary-owned; AND
    Date the patient obtained the equipment. NAME/MAKE/ & MODEL
                          K0462
Each claim submitted must include:

   Information on Equipment being repaired
 Complete description (manf. model etc)
 Date purchased and by whom (can use base code)
 Information on loaner equipment: (Can use base code)
 Complete description /name/make/model
 Description and time needed for repairs
It is not required to be billed on same claim as repair but
    works better if you do

Why repair took longer than one day
Suggest that you use the DMEPDAC code for item loaned as
  well to make pricing simpler.
                       MODIFIERS
   KX modifier is required on accessories
   K0462 does not require any modifier
   RA (effective date 1-1-09) is the replacement of the DME
         item itself (entire item is being replaced)
   RB (1/1/09)Replacement of a part of DME furnished as
         part of a repair
   E0739 (4/1/09) does not require any modifiers but does
         require a break out of unit needs.
   ** RP** deleted as of 1/1/09 {E1340 deleted 4/1/09}
   Use K0739 for labor on/after 4/1/09
   DO NOT FORGET the KE modifier on any part or accessory that could
    be part of round 1 CB base item
   NO KE required on bases still use on Manual w/c accessories
   KK is replacement modifier for CBAs – for accessories on complex rehab
    bases that could be provided on group 2 CB items
   IN CBAs parts will be paid at the CB price (CAUTION) you do not want to
    go there – REMEMBER pts. in CB area can’t do non assigned.
                 Repair Questionnaire
Patient Name:
Medicare No.
Address:

Name, Make & Model of the item that is being repaired: ________________
Serial number of item being repaired: ________________
Date wheelchair (item) was provided: __________________
How was wheelchair (item) funded? (pay or source) ______________
Loaner chair given? Name ______ Make ________ Model ________
(----- code as well – for pricing information for K0462)
If funded by Medicare was chair (item) purchased or rented? ________

If the wheelchair (item) was provided by a company other than
    ____________________________ the information above must be
    confirmed by the supplier ( if the supplier is unknown to the patient or
    out of business check per the VRU at Medicare for order date.

   Confirmed by: _______________(employee) Date: __ __ ____
*** NEED justification of continued need .***
         MCM replacement policy
   If the item of equipment has been in “continuous” use by
    the patient on either a rental or purchase basis for the
    equipment’s useful lifetime, the “beneficiary” may “elect”
    to obtain a new piece of equipment. Replacement may be
    reimbursed when a new physician order and/or CMN,
    when required, is needed to reaffirm the medical necessity
    of the item.

   …useful lifetime is determined through program
    instructions. In the absence of program instructions the
    “carriers” may determine the reasonable useful lifetime but
    at no time can it be “less than” 5 years.
                                     KE Modifier List
Standard Power Accessories
    E0950 through E0957, E0960, E0973, E0978, E0981, E0982, E0990, E0995, E1016, E1020, E1028,
    E2208, E2209, E2210, E2361, E2363, E2365 through E2371, E2381 through E2392, E2394, E2395,
    E2396, E2601 through E2608, E2611 through E2616, E2619, E2620, E2621, K0015, K0017 through
    K0020, K0037 through K0047, K0050 through K0053, K0098, K0195, K0733 through K0737,
Complex Rehabilitative Only Accessories
    E1002 through E1008, E1010, E1029, E1030, E2310, E2311, E2321 through E2330, E2351, E2373
    KC*, E2374 through E2377
    (* When E2373 is used as a replacement only on a competitively bid complex rehabilitative product
    (K0835 – K0864), use the KC modifier but not the KE modifier. When used as a replacement only on
    a non-competitively bid manual or miscellaneous wheelchair, use the KE modifier, but not the KC
    modifier.)
The KE modifier should also be used for tips (A4637) and hand grips (A4636) when used on a non-
    competitively bid cane or crutch, but not when used for a competitively bid walker (E0130, E0135,
    E1040, E0141, E0143, E0144, E0147, E1048 or E0149).
The disposable canister code (A7000) requires the KE modifier when used with respiratory or gastric
    suction pumps, but not when used for a competitively bid negative pressure wound therapy (NPWT)
    pump (E2402).
When providing an IV pole (E0776) with non-competitively bid parenteral nutrient codes, use the KE
    modifier, but not the BA modifier. When providing the IV pole for competitively bid enteral nutrient
    codes (B4149, B4150 and B4152 through B4155) use the BA modifier, but not the KE modifier.
      KE Modifier example billing
   January 1, 2009 the KE modifier was added to show that
    an item/accessory billed is being used on a non competitive
    bid item so that the allowable will not be decreased 9.5%
   When billing for two units that requires the RT and LT
    modifier use:
   E0973NUKERT99 then in narrative field put the LT and KX
    modifiers.
   NU for new – KE for non CB item-RT for right -99
    (>4modifiers required) LT (left) KX (doc. on file for Medical
    necessity
Type of                Part Being    Allowed Units of
Equipment           Repaired/Replaced Service (UOS)

Power Wheelchair    Batteries (includes      2
                    cleaning and testing)
Power Wheelchair    Joystick (includes       2
                    programming)
Power Wheelchair    Charger                   2
Power Wheelchair    Drive wheel motors       2/3
                    (single/pair)
Power or Manual     Wheel/Tire (all types,   1
Wheelchair          per wheel)
Power or Manual     Armrest or armpad        1
Wheelchair
Power Wheelchair    Shroud/cowling           2
Manual Wheelchair   Anti-tipping device      1
Hospital Bed        Pendant                  2
Hospital Bed        Headboard/footboard      2
CPAP                Blower Assembly          2
Seat Lift           Hand Control             2
Seat Lift           Scissor mechanism        3
Patient Lift        Hydraulic Pump           2
        REPAIR AUDITS 2010/2011
   Asking for face to face for power
   Asking for proof of continued Medical necessity for all
    items ** IMPORTANT IF YOU DID NOT PROVIDE
    THE EQUIPMENT**
   Look back period past 6 months
   What this means is that you need to make sure the item
    you are providing has documentation of continued need
    within the past 6 months.
   If no original face to face for power it is best to make
    sure you have one.
   This is resulting in need for ABNs and lots of non-
    assigned claims