Watch Out for the KE Modifier

On Jan. 1, 2009, the KE modifier hit the HME stage. Since then, this little modifier has been causing some providers a lot of anxiety and stress.

What is the KE modifier? It’s a pricing modifier that providers must use to identify when the same HCPCS accessory code can be furnished in multiple competitive and non-competitive bidding product categories.

All fee schedules for power mobility device accessory codes with the KE modifier will receive a 5 percent covered item update for 2009, whereas those billed without the KE modifier will receive a required 9.5 percent reduction for 2009.

The correct placement of the KE modifier will determine whether you get an increase or a decrease in reimbursement, so it is very important to understand its use.

Providers must use the KE modifier to identify when the same accessory HCPCS code can be furnished in multiple competitive and non-competitive bidding product categories. For example, HCPCS code E0981 (wheelchair accessory, seat upholstery, replacement only) can be used with both competitively bid standard and complex rehabilitative power wheelchairs (K0813-K0829 and K0835-K0864), as well as with non-competitively bid manual wheelchairs (K0001-K0009) or a miscellaneous power wheelchair (K0898).

The KE modifier should be appended to the E0981 if it is an accessory for a K0001 manual wheelchair (the non-competitively bid base item). The KE modifier is used to identify an accessory code that can be dually billed with either a competitive or non-competitive bid base item, and it must be appended to the accessory code if it is billed with a non-competitively bid base item.

The effective dates of service for the KE modifier are on or after 01/01/2009. If a reduction in payment is received inappropriately, you can contact the telephone re-openings line at your DME MAC to request that the KE modifier be added to the claim.

In addition, appending the KE modifier to a HCPCS code in error may cause a CO-4 rejection with the message “the procedure code is inconsistent with the modifier used.” Claims rejected in this manner should be resubmitted without the KE modifier.

Another important note: You should not use the KE modifier on any claims for items that were included under Round One of competitive bidding, such as an accessory for a standard or complex rehabilitative power wheelchair.

The DME MACs have given instructions on the various situations and HCPCS combinations for the use of the KE modifier. Visit your DME MAC Web site to find the specific tables that can assist with your claims processing.

Sarah Hanna is a reimbursement consultant and vice president of ECS Billing & Consulting, Tiffin, Ohio, and specializes in proper billing protocols, Medicare coverage guidelines and billing office procedures. You can reach her at 419/448-5332 or [email protected].

A note from Sarah: “Some of the wording in this column on proof-of-delivery documentation (March 2009) may have been confusing. Obviously a signature from the patient or designee is not required when using the shipping service option. If you have questions on proof-of-delivery, please let me know.”