Be Repair-Aware

Coding for repairs is confusing at best. Reimbursement specialists need to work hand-in-hand with their company’s repair technicians in order to make sure that the documentation of the repair and parts used are in line with the policy. When billing for repairs keep the following in mind:

Effective for dates of service on or after April 1, 2009, the DME MACs instituted a billing and payment policy for common repairs based on standardized labor times. This applies to non-rented and out-of-warranty items.

This effective date coincides with the effective date of the new code for repairs for non-oxygen equipment, K0739 (repair or non-routine service for durable medical equipment other than oxygen requiring the skill of a technician, labor component, per 15 minutes). One unit of service equals 15 minutes. Code E1340 is no longer valid for repairs for dates of service on or after April 1, 2009.

The following table released by the DME MACs contains repair units of service allowances for commonly repaired items. Units of service include basic troubleshooting and problem diagnosis. Remember, there is no Medicare payment for travel time or equipment pick-up and/or delivery.

Providers may only bill the allowable units of service listed in the table for each repair, regardless of the actual repair time. Claims for repairs must include narrative information itemizing each repair and the time taken for each repair. Providers must provide the required narrative explanation in the NTE field. Also, remember that Medicare does not pay for repairs to capped rental items during the rental period or items under warranty.

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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].