Downsize Those DSOs

HCPCS Code E0607
(Home blood glucose monitor)

Average Medicare DSO
87 days

Incorrect use or non-use of modifiers and diagnosis codes are a major reason the home blood glucose monitor has a higher-than-average DSO. If the patient is being treated with insulin injections, the KX modifier must be added to the code for the monitor and each related supply on every claim submitted. If the patient is not being treated with insulin injections, the KS modifier must be added on every claim. If the claim is submitted without the appropriate modifier, it will be denied with a CO50 denial reason code.

The ICD-9 diagnosis code describing the condition that necessitates glucose testing also must be included on each claim for the monitor, accessories and supplies. It is important to have the appropriate diagnosis that states whether the patient is insulin vs. non-insulin dependent. The diagnosis must match the modifier which is attached to the HCPC.

The same/similar denial (CO-57 M3) is another common problem for E0607. Intake personnel should verify that the patient doesn’t already have a monitor before dispensing a new one. Sometimes the patient may already have a monitor, but the supplies are no longer available for that model or brand. If you decide to dispense another monitor, make sure to have an advanced beneficiary notice signed by the patient or caregiver. In addition, be aware of the requirements regarding the detailed written order and documentation required in the patient’s medical record to prove testing frequency and medical necessity. Refer to your region’s medical policy for detailed coverage criteria.

Data represents a categorized and weighted analysis of approximately 1.6 million Medicare paid claims between Oct. 1 and Oct. 31, 2006, and processed for RemitDATA customers. Figures reflect the average number of days elapsed from date of service to the Medicare check issue date. Source: RemitDATA, 866/885-2974, www.remitdata.com

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. She can be contacted at 419/448-5332 or [email protected].