RAC Audit Identifies Overpayments for Billing Incorrect DME Codes
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.
Mechanical In-Exsufflation
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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