Health Information Management

Tip: Ensure accurate billing of no-cost devices

APCs Insider, November 18, 2011

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When a replacement device is provided at no cost, coders or another hospital staff member must append modifier -FB (item provided without cost to provider, supplier or practitioner, or credit received for replacement device [Examples, but not limited to: covered under warranty, replaced due to defect, free samples]) to the HCPCS procedure code.

Be sure to append the modifier to the procedure code—not the device code. The device code has status indicator N and has no payment attached to it.

Also ensure that the cost you report for the free device is less than $1.01. Doing so will avoid triggering an outlier payment.

A facility that receives full credit for an old device that it replaces with a newer, improved device should report the difference between the credit for the old device and the charge for the new one. Report condition code 49 (malfunction) or 50 (recall) on the claim.

Table 26 of the 2011 OPPS final rule lists the CPT® codes that denote devices to which the no-cost/full- and partial-credit device adjustment apply. Table 25 includes a list of APCs to which the adjustment applies.

The tip is adapted from “Correctly bill for free, reduced-cost devices” in the November Briefings on APCs.



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