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Billing DMREC

  1. #1
    Default Billing DMREC
    Medical Coding Books
    I need some help in billing DMREC for parenteral nutrition supplies (Pumps, administration kits, supply kits, nutrition solutions, etc). We are billing:
    B9004 with a KJ modifier for the pump.
    B4224 for the administration kit,
    B4220, supply kit, premix.
    B4185 solution, per 10 grams lipids and
    B4189, soluation....premix.

    We keep getting denied for procedure/modifier invalid. We are in Georgia. Any help would be greatly appreciated. Thanks in advance.


  2. Default Dmrec
    Hi pygreen,

    Do you have access to Ingenix Encoder Pro?

    You can enter the codes and in that database all the modifiers that can be billed with any CPT or HCPCS code will be listed.

    Now you may want to contact the payer because they may have in their system what modifiers are appropriate for what codes and which modifers are not.

    Hope this helps.

    happycoder07 = Pedenia Evans, CPC

  3. Default
    I suspect it could be the modifier that's causing your denial. It is important to use the modifier that indicates the correct rental month. The first three months of a capped rental item is calculated to limit the monthly rental to 10% of the allowed purchase price. Therefore, the KH modifier must be used on the first month and KI on the second and third months.

    For each additional month, the allowance is reduced to 7.5% of the allowed purchase price. Therefore, the KJ modifier must be used for months four through thirteen.

    If you're sure the monthly count is correct, call the payor (as painful as that sometimes is).

  4. #4
    Thanks Julie. The modifer is correct. This DOS falls witin that range of months. I wanted to check and make sure the code was correct before I called the Carrier.

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