Characters for Procedures
Since the development of the new classification system, both procedure codes and diagnosis codes are much more specific in reference to their exact function. This allows the billing process to be more precise as well. The characters for procedures are:
- Character 1: Section
- Character 2: Body System
- Character 3: Root Operation
- Character 4: Body Part
- Character 5: Approach
- Character 6: Device
- Character 7: Qualifier
Billing for Durable Medical Equipment
Durable medical equipment (DME) is any medical equipment used at home to help with gaining a better quality of living. This includes but is not limited to prosthetics. Until recently, this kind of equipment was not included in most insurance policies, but is now usually a part of them. An example of durable medical equipment is a cochlear implant, which is a device used to aid hearing impaired people to be able to hear better. The code for this procedure according to the ICD-10-PCS is F0BZ09Z.
The “F” represents the section of Physical Rehabilitation and Diagnostic Audiology. The “0” indicates that the body system is rehabilitation. The “B” shows that the root operation is a cochlear implant treatment. The “Z” shows that there is no need to designate a body part since one was already defined in the previous categories. The “0” indicates uses an open approach to implanting the device. The “9” represents the use of cochlear implant equipment in the procedure, and the “Z” indicates that there is no need for a qualifier in this code.
Of course, there are other types of durable medical equipment out there, and their billing codes are different than the one for a cochlear implant. For instance, if a patient were to undergo a hip-replacement procedure after a car accident the code would be 0SR9019, but the code for the equipment that the patient would need following the hip replacement like a walker or a powered wheelchair would be coded something different.
If a person needed a wheelchair, he or she would be coded as Z99.3. This is one of the ICD-10’s diagnosis codes that corresponds to different meanings and aspects of the billing process. Even if the patient is only wheelchair bound temporarily, this code would be implemented.
The billing codes for durable medical equipment are broad because there can be so many different circumstances surrounding the need for this type of equipment. Durable medical equipment can be anything from a wheelchair to cochlear implants to complete or partial prosthetics.
For this reason, it is important to note not only what kind of durable medical equipment is required but also what the circumstances caused a need for this type of equipment. Noting this will make the coding process for billing simpler and will allow the insurance company to have a better understanding of the diagnosis and procedure.
MPMR is a premier DME medical billing company. Services offered include Certified Coders and Medical Billing Specialists with over two decades experience. If you would like a free consultation with a top notch durable medical equipment billing company, call MPMR today!