by Margaret Klasa DC, APN BC
RAC Region C contractor Connolly posted 2 automated reviews for DME providers on April 8, 2014, regarding Mechanical In-exsufflation Devices, High Frequency Chest Wall Oscillation Devices, and Urological Supplies. Per the contractor’s description of these issues, overpayments were identified where ICD-9-CM coding was not in accordance with billing requirements outlined in Local Coverage Determinations (LCD) for DME devices.
HCPCS CODES
Group 1 Codes:
| A7020 | INTERFACE FOR COUGH STIMULATING DEVICE, INCLUDES ALL COMPONENTS, REPLACEMENT ONLY |
| E0482 | COUGH STIMULATING DEVICE, ALTERNATING POSITIVE AND NEGATIVE AIRWAY PRESSURE |
ICD-9-CM Codes that Support Medical Necessity
Group 1 Paragraph: The presence of an ICD-9-CM code listed in this section is not sufficient by itself to assure coverage. Refer to the section on “Coverage Indications, Limitations and/or Medical Necessity” for other coverage criteria and payment information.
Group 1 Codes:
| 138 | LATE EFFECTS OF ACUTE POLIOMYELITIS |
| 335.0 – 335.9 | WERDNIG-HOFFMANN DISEASE – ANTERIOR HORN CELL DISEASE UNSPECIFIED |
| 340 | MULTIPLE SCLEROSIS |
| 344.00 – 344.09 | QUADRIPLEGIA UNSPECIFIED – OTHER QUADRIPLEGIA |
| 359.0 | CONGENITAL HEREDITARY MUSCULAR DYSTROPHY |
| 359.1 | HEREDITARY PROGRESSIVE MUSCULAR DYSTROPHY |
| 359.21 | MYOTONIC MUSCULAR DYSTROPHY |
| 359.71 | INCLUSION BODY MYOSITIS |
High Chest Wall Oscillation
HCPCS CODES
Group 1 Codes:
| A7025 | HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM VEST, REPLACEMENT FOR USE WITH PATIENT OWNED EQUIPMENT, EACH |
| A7026 | HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM HOSE, REPLACEMENT FOR USE WITH PATIENT OWNED EQUIPMENT, EACH |
| E0483 | HIGH FREQUENCY CHEST WALL OSCILLATION AIR-PULSE GENERATOR SYSTEM, (INCLUDES HOSES AND VEST), EACH |
ICD-9-CM Codes that Support Medical Necessity
Group 1 Paragraph: The presence of an ICD-9 code listed in this section is not sufficient by itself to assure coverage. Refer to the section on “Coverage Indications, Limitations and/or Medical Necessity” for other coverage criteria and payment information.
Group 1 Codes:
| 011.50 – 011.56 | TUBERCULOUS BRONCHIECTASIS UNSPECIFIED EXAMINATION – TUBERCULOUS BRONCHIECTASIS TUBERCLE BACILLI NOT FOUND BY BACTERIOLOGICAL OR HISTOLOGICAL EXAMINATION BUT TUBERCULOSIS CONFIRMED BY OTHER METHODS (INOCULATION OF ANIMALS) |
| 138 | LATE EFFECTS OF ACUTE POLIOMYELITIS |
| 277.00 | CYSTIC FIBROSIS WITHOUT MECONIUM ILEUS |
| 277.02 | CYSTIC FIBROSIS WITH PULMONARY MANIFESTATIONS |
| 277.6 | OTHER DEFICIENCIES OF CIRCULATING ENZYMES |
| 335.0 – 335.9 | WERDNIG-HOFFMANN DISEASE – ANTERIOR HORN CELL DISEASE UNSPECIFIED |
| 340 | MULTIPLE SCLEROSIS |
| 344.00 – 344.09 | QUADRIPLEGIA UNSPECIFIED – OTHER QUADRIPLEGIA |
| 359.0 | CONGENITAL HEREDITARY MUSCULAR DYSTROPHY |
| 359.1 | HEREDITARY PROGRESSIVE MUSCULAR DYSTROPHY |
| 359.21 – 359.29 | MYOTONIC MUSCULAR DYSTROPHY – OTHER SPECIFIED MYOTONIC DISORDER |
| 359.4 – 359.6 | TOXIC MYOPATHY – SYMPTOMATIC INFLAMMATORY MYOPATHY IN DISEASES CLASSIFIED ELSEWHERE |
| 359.89 | OTHER MYOPATHIES |
| 494.0 | BRONCHIECTASIS WITHOUT ACUTE EXACERBATION |
| 494.1 | BRONCHIECTASIS WITH ACUTE EXACERBATION |
| 519.4 | DISORDERS OF DIAPHRAGM |
| 748.61 | CONGENITAL BRONCHIECTASIS |
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* This article by Margaret Klasa, DC, APN, Bc, was originally published in the online version of the RACmonitor.
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