Prevent DME Documentation Errors at your O&P Facility

1. Prevent DME Documentation Errors at your O&P Facility Medical Billers and Coders

2. Items of DME (Durable medical equipment) that is deemed necessary for medical reasons come under Part B of Medicare. These items need to be long lasting and be good for a minimum of 3 years, and the doctor prescribing such equipment needs to fill out a detailed order in writing. Some commonly prescribed durable medical equipment include commodes, oxygen equipment, continuous passive motion (CPM) machines, crutches, special hospital beds, lifts, traction equipment, walkers, and more.

3. Most of the Orthotic and Prosthetic claims end up being denied because of documentation that contains errors. Durable medical equipment billing services providers need to ensure that the DME insurance verification procedure is followed so that the physician receives the correct reimbursement due for services rendered. According to a review conducted by the American Orthotic and Prosthetic Association National Assembly a couple of years ago, error rates were found to be high for lower limb orthoses and lower limb prostheses for Region A and B, and were low for B and D. Medical records were the culprits for lower limb orthoses claims, it was the replacement records that were responsible for errors found in lower limb prostheses claims.

4. Durable medical equipment billing companies should be aware that Medicare covers repairs and replacement parts for DME items. However, Medicare pays only 80% of the approved amount for purchasing the DME item. Medicare also reimburses 80% of the expenses incurred for repairs or such DME items, which includes replacement costs as well. However, the justification for the repair needs to be provided by thorough proper documentation by the supplier or physician. • The various codes are: • L7510 for the repair of prosthetic devices, including repairs and replacement of minor parts. • L7520 for repairs to prosthetic devices including the labor component (per 15 minutes) • L4210 for repairs to orthotic devices, including repairs and replacement of minor parts. • L4205    for repairs to orthotic devices including the labor component (per 15 minutes)

5. Thus with ways in which errors can be avoided must be adhered to, however more important is to be aware of the possible errors. DME billing companies should note that the labor code can be applied for the actual time involved for genuine repairs, or medically required adjustments that were carried out 90 days after delivery/installation.

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