What Code Shall I Use?

If you do not adapt well to change, then the DME industry is not for you.

It is vital that owners, managers and employees download Medicare updates on a daily basis to keep current. Diagnosis codes are changing, HCPCS codes are being deleted, changed or added constantly, criteria changes, modifiers change and coverage changes. Appoint someone within your corporate structure to download and print updates and to place the updates, as well as the DMERC manual, on your server. No more getting up and trying to find the manual, or my favorite excuse, “We do not have a Medicare Manual.” Yikes!

In auditing companies this year, it has become apparent that some providers do not keep current with updates. This results in denials, higher DSO (days sales outstanding), poor reimbursement — and very high blood pressure.

You should certainly be aware of recent wheelchair accessory and wheelchair cushion changes. One of your top denials may be the CO-16 denial, which basically means that you are missing relevant information necessary to process a claim. The primary reasons are usually that diagnosis codes are not specific or that HCPCS codes are incorrect. On Jan. 1 of this year, most of the code changes for wheelchair accessories went into effect with the normal three-month grace period. That means you should have had the old codes changed in your inventory and ready to bill by April 1, 2004. (Of course, you could have begun using these codes as of Jan 1, 2004.)

Also designate someone in your company to keep current with HCPCS code changes and to get them into your computer system. The new codes will need to be placed on your CMN for dates of service on or after April 1, 2004.

I have selected the following often-utilized HCPCS codes relating to wheelchair accessory changes that I hope you will find helpful. Make certain your staff is also informed.

Be aware of the changes as they are announced. CMS is planning a revision in 2005 for bundling of wheelchairs with the most common accessories into a collection of new codes. It will become even more crucial for providers to be sure that everything they deliver is billed appropriately.

Jane Bunch is CEO of Kennesaw, Ga.-based JB&CS. A reimbursement specialist, Bunch delivers educational seminars worldwide, helps develop corporate compliance plans, and serves as a consultant for fraud and abuse cases. She can be reached at 678/445-1221 or via e-mail at [email protected].