Morgan Posted Sun 16th of October, 2016 17:58:13 PM
My company manufactures an FDA Cleared Alcohol Monitoring Device that is required to be wirelessly connected to our Monitoring Web Portal. We rent the Device for a monthly fee which also covers the monitoring of the patient's test results. There is currently no HCPC code for our specific medical device, so we are on the path of acquiring denial letters from doctors who are prescribing our product to then present to the HCPC committee.
In order to get denial letters, the doctors need to use a HCPC code to submit the claim. Should our doctors be using Misc. Code E1399 for the combined rental fee? Or is there another code that would cover the rental fee for the device & monitoring, which costs $200 a month and is typically prescribed for 6 to 12 months.
SuperCoder Answered Mon 17th of October, 2016 05:40:50 AM
Greetings from SuperCoder!
There is no specifice HCPCS code for Alcohol Monitoring Device. You may report code A9279 for billing. Please tell your providers to use HCPCS code A9279 for billing of Alcohol Monitoring Device and they should append modifiers for renting these equipments. The modifiers are:
- BR - The beneficiary has been informed of the purchase and rental options and has elected to rent the item
- NR - New when rented (use the NR modifier when DME which was new at the time of rental is subsequently purchased)
- RR - Rental (use the RR modifier when DME is to be rented)
Please feel free to write if you have any further questions.
Morgan Posted Mon 17th of October, 2016 15:48:28 PM
Thank you. So, for clarity, are the below situations accurate?:
1. Provider purchases the device and only wishes to submit claims for the monthly monitoring fees. Provider would use code A9279
2. Provider chooses to rent the device and submit claims for the combined monthly fee of the rental and monitoring. Provider would use code A9279BR
3. Provider is required to rent the device and submit claims for the combined monthly fee of the rental and monitoring. Provider would use code A9279RR
Lastly, am I able to advise our providers to use these codes when submitting claims, and state that they were suggested by Supercoder.com? The reason I'm asking is that I've been informed that only Coders are eligible to determine and give advice on a code.
SuperCoder Answered Tue 18th of October, 2016 02:10:28 AM
Greetings from SuperCoder.com!
Please note the correct usage of these modifiers:
- BR should be used only when the provider has discussed both options with beneficiary to either purchase the item or take the item on rent, and the beneficiary has elected to take the item on rent.
- NR should be used in case the item was new when the beneficiary took it on rent but later purchased that item.
- RR should be used only when provider has decided only to rent the item.
Since we have an excellent team of coders, billers, auditors, and editors, you can absolutely tell your providers that these are suggested by Supercoder.com.
We hope this helps you.
Morgan Posted Wed 19th of October, 2016 20:15:30 PM
Hi, Do you think Code E1399 would work for our system? Do you have any other suggested codes?
SuperCoder Answered Thu 20th of October, 2016 00:59:03 AM
The series of codes A9272 - A9280 signifies the supply of medical and surgical equipments for patients who require regular monitoring of their condition using monitoring devices. So you should bill HCPCS code A9279 for your Alcohol Monitoring Device. Moreover, you may contact your payers to confirm if they pay CPT codes E1399 and A9279 for Alcohol Monitoring Device and what is the payment amount. Then based on this information, you may bill the code with higher amount.