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Medicare dme modifier

  1. #1
    Location
    Chicopee, Mass
    Posts
    75
    Default Medicare dme modifier
    Medical Coding Books
    Hello,

    My Tufts Medicare Preferred denied a claim for code L4360 stating I needed a modifier. I applied the LT and they still denied stating they needed an additional modifier- and told me to see Medicare Guidelines. Anyone have any answers for me???? I need someone's expertise..

    Thanks!!
    Valerie

  2. Default GY modifier (Tx/pressure ulcer)
    Quote Originally Posted by Valerie813 View Post
    Hello,

    My Tufts Medicare Preferred denied a claim for code L4360 stating I needed a modifier. I applied the LT and they still denied stating they needed an additional modifier- and told me to see Medicare Guidelines. Anyone have any answers for me???? I need someone's expertise..

    Thanks!!
    Valerie
    ---------
    It is GY modifier.

    If a walking boot L4360 is used solely for the prevention or treatment of a pressure ulcer, the GY modifier must be added to the base code and to the code for the replacement liner (L4392, L4394).
    When the GY modifier is added to a code there must be a short narrative statement indicating why the GY modifier was used – e.g., “used to prevent pressure ulcer” or “used to treat pressure ulcer” or “used to treat edema”. This statement should be entered in the narrative field of an electronic claim or attached to a hard copy claim.


    Thanks

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