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DCS Healthcare posts new DME claim RAC issues

Recovery Auditor Report, January 7, 2010

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DCS Healthcare has added six RAC issues for DME claim review to its CMS-approved list for providers in all Region A states.

According to the DCS Web site, the new issues are as follows:

• Wheel attachment with new non-wheeled walker. Wheel attachment (E0155) cannot be paid on the same day or within one month of the initial issue of a nonwheeled walker. Therefore, an issue may exist when a beneficiary receives this wheel attachment, which has been billed and reimbursed under Medicare Part B, within a month of an initial issue of a nonwheeled walker.
• Headrest with a power operated vehicle or a power wheelchair with a captain’s chair seat. Headrests (E0955) may not be billed the same date of service as a Power Operated Vehicle (POV) or Power Wheelchair (PWC) with a captain’s chair seat. Therefore, an issue may exist when a beneficiary receives a POV or PWC with a captain’s chair seat and a headrest, which has been billed and reimbursed under Medicare Part B, on the same date of service.
• Multiple DME rentals within a month. Certain procedure codes may not be billed in conjunction with other procedure codes for the same date of service and for the same beneficiary. Therefore an issue may exist when these codes are billed reimbursed under Medicare Part B on the same date of service and for the same beneficiary.
• Prosthetic additions with initial or preparatory knee prosthesis. When an initial below knee prosthesis (L5500) or a preparatory below knee prosthesis (L5510-L5530, L5540) is provided, prosthetic substitutions and/or additions of procedures and components are covered in accordance with the functional level assessment, except for certain codes. Therefore, an issue may exist when these codes are billed and reimbursed under Medicare Part B with such a prosthesis.
• Lower limb suction value prosthesis. Codes L5647 and L5652 incorporates a suction valve in its design, therefore separate payment is not allowed for code L5671 which was created to specifically to address suspension sockets using mechanical locking mechanisms. This code was not meant to be an “add on” for suction suspension. Therefore, an issue may exist when such a locking mechanism is billed and reimbursed under Medicare Part B along with a suction valve suspension.
• Solid Insert with seat or back wheelchair cushions. Code E0992 (solid seat insert) is not separately payable when provided with a seat or a seat back wheelchair cushion. Therefore an issue may exist when E0992 is billed and reimbursed under Medicare Part B with a seat or seat back wheelchair cushion.

To stay on top of the latest RAC-approved issues in your state, visit the “Tools” Section of the Revenue Cycle Institute Web site and download the updated chart at the top of the page.

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