Reimbursement & Coding Information

HCPCS Coding Guidance – The link provided below contains Coverage and Payment Rules, codes and general guidelines for seeking DME reimbursement through Medicare. These guidelines do not replace directions provided by CMS. Amerx Health recommends checking with PDAC for the latest updates regarding rules and regulations for dispensing DME products. PDAC – www.dmepdac.com


The Latest in Reimbursement & Coding Information from the Blog

Special Notice: Recent Change Announced by CMS

Change in Order Requirements for DME Dispensing In a MLN Matters article dated October 12, 2018, CMS announced a change in order requirements for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). Effective November 13, 2018, “when the prescribing practitioner is also the supplier, and is permitted to furnish specific items of DMEPOS, a separate […]

A- Modifier

Billing For Surgical Dressings: A- Modifiers

One of the most important steps to ensure clean billing of surgical dressings is the appropriate use of the A- modifier.  The A- modifier must be used to indicate two things: Is the dressing billed for a primary or secondary dressing? How many wounds are being treated with the dispensed dressing?  An important differentiation is […]

Dr. Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

Separately Identifiable E/M Demystified

Does dispensing surgical dressings at the same encounter as an ulcer debridement count as an evaluation and management (E/M)? Short answer: Probably not. Longer answer: It depends. It depends on what was performed, documented, and medically necessary.  You can submit an E/M at the same time as a debridement (or any procedure) if—and only if—an […]

AMERX® Wound Care Kit - Hydrogel

Coding For A Debridement? Be Sure Your Diagnosis Code Makes Sense.

The surgical dressings available from AMERX Health Care are only covered by a patient’s insurance if they are being used for a surgical wound or a debrided wound.  This debridement can be surgical, mechanical, chemical or autolytic.  When performing a surgical debridement, both the CPT code selection and ICD-10 code selection are important. CPT Coding […]