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RAC Audit Identifies Overpayments for Billing Incorrect DME Codes

  • by Margaret Klasa DC, APN BC
  • Jul 22, 2014, 16:38 PM

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.

Incorrect ICD-9-CM Codes Used When Billing for DME 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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* This article by Margaret Klasa, DC, APN, Bc, was originally published in the online version of the RACmonitor.

Want more info on RAC audits? RAC Drill Down - Cetuximab & Medical Necessity

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