This has become a major issue for our industry. The US Rehab division is working daily to attempt to clarify some of the issues we are having because of the Competitive Bid round 2 as of July 1, 2013
I thought it might help if I give you few questions that I have received to assist your staff in correcting any issues they are seeing.
1. Are the K0005 and E1116 part of the complex rehab codes? YES
2. Do I use the KY modifier on the base of a chair? NO
3. What accessories should have the KY modifier?
Any accessory that could be used on a CB base but is being billed on a complex rehab base such as a head rest.
4. What other modifiers must I use? Any other modifier that is required NURBKYKX —
5. What if I have more than 4 modifiers? Use the 99 in the fourth space and then put all modifiers in the narrative loop for that line item — NURBKY99 line item would put in NURBKYKXRTLT if you needed to add the Right and Left modifiers.
Other issues are the fact that there is still no clear definition as to exactly what the non CB provider can do vs the CB provider.
1. If it is being “repaired/fixed” the non bid provider can do BUT you are only going to get the CB price and you still must realize that you have to have the documentation of continued need as well as knowing the need was there on initial date IF you did not provide.
It is up to each individual provider to decide how they are going to handle the repairs on a CB base.
There are several different problems we face.
Did our company provide the chair?
NO — then I suggest you do non-assigned with an ABN if patient does not want Medicare billed you can do this.
YES — then you will have to make sure this is a repair (fix) of the CB items even the accessories.
IF CB patient I suggest that if you can’t do it non assigned with an ABN you refer them on to a CB provider.
This is now when we have the patients contact the 1 800 Medicare number first to complain and than have them contact People for Quality Care at _____________-
People for Quality Care is receiving over 100 complaints per day and this is being documented to show legislatures the failure of the CB and continue to use this to fight to repeal this.
Jurisdiction D has stated they are having issues with processing the claims with the KY modifier so they have requested the suppliers hold these claims. As soon as I get an update I will let all of our members know.
Please call or e-mail me if you are having specific issues.
Peggy Walker, RN
Directory of Reimbursement Services
877 907 3862