Durable Medical Equipment is available for your patients, but a number new issues have been introduced by CMS, and Other insurance companies. In the last few years, CMS has introduced the “Face to Face “ Rule. The exam must occur within 6 months prior to prescribing the DME item(s) Exam occurrence must be documented in the patient’s medical record.
The exam must include and document:
• Evaluation of beneficiary
• Needs assessment
• Treatment ( All previous treatments need to be listed.)
• Relevant Diagnoses ( What is the Lymphedema due to )
• Medical record must support medical need for DME ordered ( Medicare is demanding clinical notes, not letters of medical necessity. )
The signed DME item order is not sufficient.
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the physician must provide the medical record documentation to the DME supplier, as well as the written order and any supporting documentation
CMS may request this documentation up to 7 years.
1. Date of the order
2. Beneficiary name ( As it appears on their Medicare Card. )
3. Item of DME ordered
4. The prescribing physician’s NPI (national provider identifier)
6. Signature of prescribing practitioner ( Sorry, RN, PA, PT signatures are not valid)
Rubber stamped signatures, nor Electronic signatures will be accepted by CMS. Only original Signatures.
Medicare, and most insurers recognize the following codes for qualifying for a Lymphedema Compression Pump. While other codes may fit your patient better, the insurance companies may not recognize those codes as a reason for a pump.
I89.0 – Lymphedema, not elsewhere classified.
I97.2 – Post mastectomy lymphedema syndrome
Q82.0 – Hereditary lymphedema
I87.2 – Venous Insufficiency (chronic) (peripheral)
I87.2 – Venous Insufficiency (chronic, peripheral) This code is commonly used with Venous Ulcers. For most insurance companies, but especially for Medicare, you must document the existence of an ulcer for six months. Anything less will be rejected by the insurer.
I87.319 – Chronic venous hypertension (idiopathic) with ulcer of unspecified lower extremity. .
These current codes must be used on all CMNs, and they must match the codes that you use in your Clinical notes, and records. It is best to enter these codes early into patient records if they have this condition, and you think you may want to treat with a pump later. Please don’t forget notes about elevation, and compression stocking use. All insurance companies require use before a compression pump. Even if your patient can not fit into a stocking, you need to make notes about their failure to use one in your notes.
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