The Importance of Using Correct Modifiers in DME Billing And Coding

DME billing and codingUsing the correct modifier in medical coding and billing harbors the entire process. When modifiers are used in an accurate manner, DME services are well-managed.

Outsourcing DME billing and coding services are delivered with immense expertise. The service has both professional and technical components and modifiers are two digit codes appended by CPT. Similarly, a CPT modifier may describe whether multiple procedures were performed, why that procedure was necessary, where the procedure was performed on the body, how many surgeons worked on the patient, and lots of other information that may be critical to a claim’s status with the insurance payer.

CPT modifiers are added to the end of a CPT code with a hyphen. In the case of more than one modifier, you code the “functional” modifier first, and the “informational” modifier second. The distinction between the two is simple: you always want to list the modifiers that most directly affect the reimbursement process first.

Let’s go through a brief understanding, why correct modifiers are important in DME billing and coding:

♦ Modifiers are used for various reasons. Claims can be inaccurate or incomplete without a precise modifier
  Appropriate use of modifiers get services reimbursed, that might otherwise be denied
  Coding to the highest level of specificity requires modifier use
  Allows for proper reimbursements based on the procedure or service circumstances


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