By Dan Fedor, VGM Reimbursement Specialist
One of the most common denials for wheelchair repairs parts is the CO-4 (inconsistent modifier for the procedure code). Let’s review the logic behind billing these codes and have NO MORE CO-4.
As of date of service Oct. 1, 2016, all capped rental wheelchair parts billed as a repair (with the RB modifier) will pay on a lump sum (purchase) basis regardless of the base code (complex or non-complex).
Please remember that even though these codes will pay on a lump sum (purchase) basis, they are still in the capped rental payment category. What this means is they must have the KH modifier because the initial claim is still the first month of a capped rental item.
RT LT Modifiers
When billing two units of a capped rental repair part (each) on one line, the RT and LT modifiers MUST be in the 2nd and 3rd positions.
The purpose of the RB modifier is to notify the processing system that this code is a replacement part of a repair to the base item. The base item could be a power base, manual base, power tilt, removable height adjustable armrest as noted in the wheelchair options policy article Column I and Column II chart. When billing a code in Column II as a repair to a code in Column I, you must use the RB modifier, otherwise the system will think you are trying to unbundle the base code (aka, double dipping).
Below are a few examples for the most common wheelchair repair parts with appropriate modifiers:
- E2370 (motor gearbox combo) (2 units) – NURTLT99 extra narrative RBKHKX and KU if on a Group 3 power base with DOS 1/1/16-6/30/17.
- E2374 (controller) (1 unit) – NUKHRBKX and if on a Group 3 power base with DOS 1/1/16-6/30/17, the KU.
- E2361 (batteries) (2 units) – NUKX and if on a Group 3 power base with DOS 1/1/16-6/30/17, the KU (NO KH because batteries are NOT a capped rental and NO RB because batteries are not being repair but rather replaced).
- K0019 (arm pad 1 unit) on a group 2 standard base – NURTRBKX (RB is needed because it was originally included in the allowable for the base code (K0823 for example).
- E0973 (removable height adjustable arm rest 1 unit) as a replacement on a Group 2 K0823 – NUKX (NO RB because the E0973 is not included in the allowable for the K0823, and it is not being repaired but rather replaced as a whole assembly)
- E0973 (removable height adjustable arm rest 1 unit) as a replacement on a Group 2 single power base K0835 with tilt E1002)- NURBKX (YES RB as the E0973 was included in the allowable for the E1002; therefore, this is a replacement as part of a repair to the base code of E1002).
Come and learn more modifier logic and much more at VGM’s Breaking Bad Full Day CEU Reimbursement Seminar. Click here for details and registration info.
If you have any questions, please contact me at 570-499-8459 or email@example.com.