Durable Medical Equipment (DME) Coding
Key HCPCS Codes
- E0601: CPAP device
- K0001: Standard wheelchair
- A4253: Blood glucose test strips
- E0781: Ambulatory infusion pump
Documentation Requirements
✔ Face-to-face exam within 6 months prior to order
✔ Detailed medical necessity explaining why DME is required
✔ Payer-specific forms (e.g., CMS-10137 for Medicare)
Common Pitfalls
✖ Missing proof of delivery documentation
✖ Using incorrect supply codes (A-codes vs E-codes)
Ambulatory Service Coding
Common CPT® Codes
- 99202-99215: Office visits
- G0463: Hospital clinic visit
- 63650: Epidural injection (ASC setting)
Key Modifiers
- -25: Significant, separate E/M service
- -59: Distinct procedural service
- -SG: Ambulatory surgery center service
Compliance Tips
✔ Verify place of service codes (11, 22, 24)
✔ Track device-intensive procedures (e.g., 58571 hysteroscopy)
✔ Document start/stop times for time-based codes
