Reimbursement

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Saturday, May 31, 2003

New CPAP accessory codes
With Jane Bunch

Q: I am billing Medicare for continuous positive airway pressure accessories the way I always do, but almost all of my accessory claims of late are being denied. Am I missing something?

A: Be sure you are using the new “A” codes—A7030 through A7044—for CPAP accessories, which became effective April 1 as mandated by the Centers for Medicare and Medicaid Services.

The A codes replace the now defunct “K” codes—K0183 through K0189—as CMS hopes the new codes and their descriptions will enable more-specific documentation of necessary CPAP accessories.

CPAP providers should pay particular attention to new codes A7032, replacement cushion for nasal application device, each; and A7033, replacement pillows for nasal application device, pair. The two codes replace the former K0184 code, nasal pillows/seals, replacement for nasal application device, pair or single piece interface. A7033 should be used when billing for replacement pillows that protect the sides of a patient’s nose. A7032 should be used when billing for a single replacement cushion, which protects the upper bridge of a patient’s nose.

I must also reiterate how important it is for providers to check with CMS and their DMERC at the minimum weekly for updates and changes to the Medicare program. It is imperative to the health of your business. I see too many providers who not only lose money but their entire business simply because they did not know about a new regulation or a change to an existing one.

Jane W. Bunch is founder and CEO of Jane’s Billing & Consultation Services at 678-445-1221.

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