Working Down Denials

Watch Out for the KE Modifier

On Jan. 1, 2009, the KE modifier hit the HME stage. Since then, this little modifier has been causing some providers a lot of anxiety and stress.

On Jan. 1, 2009, the KE modifier hit the HME stage. Since then,
this little modifier has been causing some providers a lot of
anxiety and stress.

What is the KE modifier? It's a pricing modifier that providers
must use to identify when the same HCPCS accessory code can be
furnished in multiple competitive and non-competitive bidding
product categories.

All fee schedules for power mobility device accessory codes with
the KE modifier will receive a 5 percent covered item update for
2009, whereas those billed without the KE modifier will receive a
required 9.5 percent reduction for 2009.

The correct placement of the KE modifier will determine whether
you get an increase or a decrease in reimbursement, so it is very
important to understand its use.

Providers must use the KE modifier to identify when the same
accessory HCPCS code can be furnished in multiple competitive and
non-competitive bidding product categories. For example, HCPCS code
E0981 (wheelchair accessory, seat upholstery, replacement only) can
be used with both competitively bid standard and complex
rehabilitative power wheelchairs (K0813-K0829 and K0835-K0864), as
well as with non-competitively bid manual wheelchairs (K0001-K0009)
or a miscellaneous power wheelchair (K0898).

The KE modifier should be appended to the E0981 if it is an
accessory for a K0001 manual wheelchair (the non-competitively bid
base item). The KE modifier is used to identify an accessory code
that can be dually billed with either a competitive or
non-competitive bid base item, and it must be appended to the
accessory code if it is billed with a non-competitively bid base
item.

The effective dates of service for the KE modifier are on or
after 01/01/2009. If a reduction in payment is received
inappropriately, you can contact the telephone re-openings line at
your DME MAC to request that the KE modifier be added to the
claim.

In addition, appending the KE modifier to a HCPCS code in error
may cause a CO-4 rejection with the message "the procedure code is
inconsistent with the modifier used." Claims rejected in this
manner should be resubmitted without the KE modifier.

Another important note: You should not use the KE modifier on
any claims for items that were included under Round One of
competitive bidding, such as an accessory for a standard or complex
rehabilitative power wheelchair.

The DME MACs have given instructions on the various situations
and HCPCS combinations for the use of the KE modifier. Visit your
DME MAC Web site to find the specific tables that can assist with
your claims processing.

Sarah Hanna is a reimbursement consultant and vice president
of ECS Billing
& Consulting
, Tiffin, Ohio, and specializes in proper
billing protocols, Medicare coverage guidelines and billing office
procedures. You can reach her at 419/448-5332 or sarahhanna@bright.net.

A note from Sarah: "Some of the wording in
this column on
proof-of-delivery documentation
(March 2009) may have been
confusing. Obviously a signature from the patient or designee is
not required when using the shipping service option. If you have
questions on proof-of-delivery, please let me know."



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