In a joint publication posted in November, the DME MACs and PDAC contractor Palmetto GBA announced plans to reduce the types of multi-function ventilators billable with HCPCS code E0467. As of January 1, 2022, suppliers should use E0467 only for devices that incorporate ventilation with all four of the following functions:
Suppliers must use miscellaneous code E1399 for multi-function ventilators (MFVs) with one to three of the additional functions.
PDAC Product Classification Verification Required
The PDAC contractor added E0467 to the list of items that require coding verification. Suppliers must confirm the product classification list on the PDAC website includes the delivered product is billable with E0467.
Ventec Life Systems, Inc. is the only manufacturer with an active E0467 product classification, but not all of the company’s VOCSN line of MFV products are classified as such. The following chart from the company’s website illustrates the available features for each model:
- Oxygen delivery.
- Nebulization.
- Suction/aspiration.
- Cough stimulation.
Suppliers must use miscellaneous code E1399 for multi-function ventilators (MFVs) with one to three of the additional functions.
PDAC Product Classification Verification Required
The PDAC contractor added E0467 to the list of items that require coding verification. Suppliers must confirm the product classification list on the PDAC website includes the delivered product is billable with E0467.
Ventec Life Systems, Inc. is the only manufacturer with an active E0467 product classification, but not all of the company’s VOCSN line of MFV products are classified as such. The following chart from the company’s website illustrates the available features for each model:
Under the new rules, three of the above configurations require billing using HCPCS E1399:
Lengthy Description, Limited Space
For products that bill with E1399, suppliers must include descriptive narratives to ensure claims process correctly … and pay at the correct amount. Doing so is made difficult by the 80-character limit in the NTE narrative field. The narrative must include the following required elements:
See the problem? The description of elements in and of itself is well over 100 characters. The following is a sample narrative I created for a VCSN Pro model:
- V-C-S-N Pro - supports three additional functions (cough, suction, and nebulization - but not oxygen).
- V-C Pro - supports one additional function (cough).
- V-C - also supports one additional function (cough).
Lengthy Description, Limited Space
For products that bill with E1399, suppliers must include descriptive narratives to ensure claims process correctly … and pay at the correct amount. Doing so is made difficult by the 80-character limit in the NTE narrative field. The narrative must include the following required elements:
- Description of the item.
- All functions of the device.
- Manufacturer name.
- Product name and number.
- Supplier price list.
- HCPCS of the related item.
See the problem? The description of elements in and of itself is well over 100 characters. The following is a sample narrative I created for a VCSN Pro model:
This sample contains 73 characters using two techniques to stretch the limited space. They include:
Using miscellaneous HCPCS certainly complicates claims processing. Without a regulatory change, however, we expect properly prepared MFV claims billed using E1399 to pay the same amount as those billed using E0467.
SOURCE LINKS
https://cgsmedicare.com/jb/pubs/news/2021/11/cope23938a.html
https://www.dmepdac.com/palmetto/PDACv2.nsf/DIDC/Z5X289FZR6~Code%20Verification
https://www4.palmettogba.com/pdac_dmecs/initProductClassificationResults.do
https://www.venteclife.com/assets/pdf/VOCSN_configurations_summary.pdf
https://www.govinfo.gov/content/pkg/FR-2018-11-14/pdf/2018-24238.pdf
- No spaces.
- Camel Case (using capital letters for each word makes it easier for claim reviewers to read the narrative without spaces).
Using miscellaneous HCPCS certainly complicates claims processing. Without a regulatory change, however, we expect properly prepared MFV claims billed using E1399 to pay the same amount as those billed using E0467.
SOURCE LINKS
https://cgsmedicare.com/jb/pubs/news/2021/11/cope23938a.html
https://www.dmepdac.com/palmetto/PDACv2.nsf/DIDC/Z5X289FZR6~Code%20Verification
https://www4.palmettogba.com/pdac_dmecs/initProductClassificationResults.do
https://www.venteclife.com/assets/pdf/VOCSN_configurations_summary.pdf
https://www.govinfo.gov/content/pkg/FR-2018-11-14/pdf/2018-24238.pdf
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