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Durable Medical Equipment Coding

Annette Posted Fri 15th of April, 2011 18:27:31 PM

I've never billed for a DME. I have no idea what codes, modifiers,etc to use. This is for a T-Joe Brace for Pectus Defects. He currently uses 97760 for initial consultation,fittings and all followups. Uses L1499 for the brace and diagnosis 754.82. Is there a global period? Any help would be greatly appreciated.

SuperCoder Answered Fri 15th of April, 2011 21:45:03 PM

Usually these codes either have a global period "xxx", i.e.,Medicare's global concept does not apply
a "000" indicator means that applies to the date of the procedure only.

So, not to worry on global period issue.

Annette Posted Mon 18th of April, 2011 12:41:19 PM

Is 97760 correct for initial consultation, fittings and all followups? Any modifiers needed? Thanks!

SuperCoder Answered Mon 18th of April, 2011 16:41:19 PM

97760 reads as follows: Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes

This means the health care provider fits and/or trains the patient in the use of an orthotic device for one or more body parts. This includes assessment as to type of orthotic when appropriate.

The wording "consultation" is not in the description, but involves the time spent in fitting and training in the use of the orthotic.
In many ways, it is meaning-wise similar to consultation, but doesn't justify as "consultation" by definition technically . Please see your documentation to decide whther it justifies the criteria of consultation or not.

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