Dispensing DME in Orthopaedics for Medicare

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Sarah Wiskerchen
Sarah Wiskerchen, MBA, CPC

Dispensing DME in Orthopaedics for Medicare – November 2017
AAOSNow
by Sarah Wiskerchen, MBA, CPC 

Answers to key coding questions
Orthopaedic practices often provide patients with supplies, such as casts and canes, integral to patients’ treatment plans.

This article covers the essentials of coding and claims submission. Understanding the definitions and rules for DME can help practices make more effective decisions on which supplies to offer patients as well as help them ensure that items are both accurately reported and appropriately paid.

The article also focuses on Medicare policy, which applies nationally.

Q. What exactly is DME?

DME—or durable medical equipment—is often used to refer to a range of supplies and assistive devices that are dispensed in a healthcare setting. However, not all of these items are classified as DME within the coding system used for billing.

According to the Centers for Medicare & Medicaid Services (CMS), DME is “medically necessary durable medical equipment, prosthetics, orthotics, and disposable medical supplies (DMEPOS), which includes oxygen and related supplies, parenteral and enteral nutrition, and medical foods.” DME is primarily used to serve a medical purpose, generally is not useful to a person in the absence of illness or injury, and is appropriate for use in a patient’s home. In some cases, DME items are rented, but in orthopaedics they are usually purchased.

Q. What supply items might be used in an orthopaedic office? How does a coder know which codes to use?

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