Durable Medical Equipment Billing- Steps to Follow
                     
Durable Medical Equipment Billing: Steps to Follow
Durable Medical Equipment Billing is different from the other medical billing and coding for the specialties. 
Unlike the other coders and billers who work on DME need specialized training to deal with different medical 
situations and equipment that require different types of modifiers as requested.  DME billers need specialized 
in-depth, specialized knowledge of different types of HCPCS Level 2 codes.
Let’s understand the procedures of coding that can be implemented to make the billing 
process more effective:
• ICD-9 codes are 3-5 digits in length and speak to the patient’s conclusion
• CPT restorative charging codes are in fact HCPCS Level I codes. They are 5 digits in length and speak to the 
methodology performed at the patient’s visit
• HCPCS codes are in fact HCPCS Level II codes. They incorporate the two numbers and letters and are likewise 
5 digits in length. These codes speak to the majority of the provisions or gear utilized in the patient’s 
consideration.
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Durable Medical Equipment Billing: Steps to Follow
All Durable Medical Equipment is arranged under HCPCS Level II. In that capacity, these are the main codes you 
will use as a DME biller or coder.
Durable equipment must be recommended by a restorative specialist, found therapeutically important, and 
afterward affirmed by the patient’s insurance agency. At exactly that point the hardware is given to the patients.
Along these lines, the strong medicinal hardware charging and coding processes are substantially more 
convoluted than ordinary charging and coding.
The Durable Medical Equipment Billing and Charging Process:
The patient must be seen by a specialist, who finds that some kind of tough restorative hardware is 
therapeutically essential for the patient’s consideration, or because of the patient’s determination. For instance, 
a tyke presents to a pediatrics practice with croup (irritation of the aviation routes). 
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Durable Medical Equipment Billing: Steps to Follow
The specialist inspects the patient and verifies that the patient will require a nebulizer treatment to regulate a 
steroid inhalant. This should be managed like clockwork for the duration of the night or until the point when the 
side effects stop. For this situation, the specialist will verify that the patient needs a nebulizer to bring home 
with them, and will endorse one to the patient.
After the patient sees the specialist and is recommended a bit of tough restorative gear, the patient will at that 
point go to a DME provider to get the provisions. What this implies for the coder is that you should find the 
supplier’s medicine and get the patient’s protection and charging data. On the off chance that important, 
because of the patient’s protection, you may likewise need to get a pre-approval. This is the place the insurance 
agency has inspected the patient’s conclusion and treatment, concurs with the discoveries, and supports the 
utilization of the DME supplies. When the majority of the essential printed material has been done, at that 
point the DME provider can find and disperse the right bit of hardware to the patient. On account of the 
nebulizer machine, the patient will give the DME provider their nebulizer machine remedy. The billers at the 
DME supply organization will do the majority of the important printed material, and furnish the patient with the 
right machine. This procedure works correspondingly to a drug solution.
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Durable Medical Equipment Billing: Steps to Follow
The last advance of the tough restorative hardware charging and coding process is doling out the right codes 
and charging the case to the patient’s insurance agency. This incorporates distinguishing the right HCPCS Level II 
codes by utilizing the HCPCS manual. This may sound simple, yet it’s vital to ensure that every single extra bit of 
the gear is coded for. For instance, the DME provider won’t simply need to give the patient the nebulizer 
machine. They’ll additionally need to give the patient the air hose tubing and the right kind of face cover, 
contingent on the patient’s age. Every one of the three of these things must be coded exclusively.
The DME biller should likewise send the case with any essential approval printed material, to ensure that the 
insurance agency will pay for the procedures.
Medical Billers and Coders (MBC) with over 10 years of experience in Durable Medical Equipment (DME) billing
 channeling the coding and billing procedures with an experienced team of coders. To know more about DME 
billing and coding contact us at 888-357-3226/ [email protected].
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