Wiki DME Procedures

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koteswararao

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Guntur, Andhra Pradesh
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Dear All,

We are getting the denial for the DME procedure code L3809 as it not covered by Medicare. Our provider is DME certified Othopedic professional provider, he done the procedure code in office. Please share your thoughts on this procedure code.
 
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What type of denial are you getting? Because it is a code that should be covered by Part D. As the only biller for my office, and having walked into a mess to clean up when I started here almost 2 years ago, it took me a lot of trial and error to start getting our DME claims paid. Do you have a lot of other DME claims that ARE going through?
 
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I also see you said that he did the procedure code in office. When billing for braces, you should use place of service code 12 for home, instead of 11 for office, since that's where the brace will be used.

Have you had any luck getting it to go through?
 
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Just wondering if you used any modifiers on the L3809. According to the HCPCS Level ll instructions you need a KH- which means its the initial claim for purchasing the DME and a NU -meaning its New Equipment. DME's notoriously are tricky to get paid.
Good Luck I hope this helps.

I have been coding and billing for 20 years now and still learn something new everyday!
Don't lose hope!

Davieda Skobel CLPN, CPC
Columbus, Ohio
 
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