Bernadette Posted Thu 18th of July, 2013 17:19:16 PM
We received a denial for the CPT code
A7003 and the reason stated this code required a modifier indicating that it is a rental or purchased. We bill this code when we perform a nebulizer treatment in office as the supplies used. Is there such a modifier?
SuperCoder Answered Fri 19th of July, 2013 01:58:31 AM
First of all, don't forget that when you add modifier 59 (Distinct procedural service), you should bill the 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device) with another service. Since this seems to be what you do, it means you're on the right track.
Although nebulizer drug (J7618-J7619, J7644) and medical supply (A7003, A7005, A7015) codes may not pay a lot, you should take the time to bill for these extra items, if the payer permits it.
Required Modifiers –NU or –RR
A modifier is always required on all HCPCS codes that are used to purchase or rent DME.
–NU for a new purchase or
–RR for a rental.
The HCPCS Section of the Professional Services Fee Schedule lists the HCPCS E codes and
the HCPCS K codes that require either –NU or –RR. Look in the HCPCS/CPT®
code column of
the fee schedule for the appropriate modifier. There is also a column in fee schedule that
designates the HCPCS code as requiring prior authorization. There is no need to obtain prior
authorization if the code doesn‘t require it.
DME codes fall into one of 3 groups relative to modifier usage. DME that is:
Only purchased (only –NU modifier allowed).
Only rented (only –RR modifier allowed).
Either purchased or rented (either –NU or –RR modifier allowed).
Bills submitted without the correct modifier will be denied payment. Providers may continue to
use other modifiers, for example –LT,–RT, etc., in conjunction with the mandatory modifiers if
appropriate (up to 4 modifiers may be used on any 1 HCPCS code)