Article Detail - JA DME

Including a narrative on the claim line when billing for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items, is often essential for timely processing. Narratives provide crucial context and information that facilitates accurate claim review and processing. Understanding when and how to include a narrative can significantly improve claim outcomes.

Where to Enter Narratives

For electronic claims, narratives should be added in the NTE 2400 (line note) or NTE 2300 (claim note) segments. For paper claims, you can enter this information in Item 19 of the CMS-1500 form.

Given that the NTE 2400 field is limited to 80 characters, using common abbreviations can help in conveying necessary information concisely.

Situations Requiring a Narrative

Here are some key scenarios where a claim narrative is mandatory or highly recommended:

1. Recurring DMEPOS Supplies
   When billing for DMEPOS accessories or supplies provided on a recurring basis, such as a three-month supply, include a narrative that indicates the duration. For example, for three months of PAP accessories, specify "90-day supply" in the NTE segment.
2. Repair Labor
   When billing for repair labor, a narrative should detail the nature of the repair performed.
3. Minor Parts without Specific HCPCS Codes
   For minor parts that do not have a designated HCPCS code, include a narrative explaining what the parts are.
4. Loaner Equipment
   When billing for loaner equipment (HCPCS K0462), include a narrative to clarify the situation.
5. Not Otherwise Classified (NOC) Codes
   Items billed with NOC codes must have a narrative explaining the service or item. This helps ensure the claim is not denied due to lack of clarity.
6. Replacing Items with Modifiers
   If you are replacing an item and appending an RA modifier due to loss, theft, or irreparable damage, provide a narrative detailing the circumstances.
7. Appending RB Modifiers
   When using the RB modifier, a narrative is necessary to explain the billing context.
8. Breaks in Need or Break in Billing
   If there’s a break in need or billing, a narrative should be included to clarify the situation.
9. Upgrades and CPM Devices
   When billing for upgrades or Continuous Passive Motion (CPM) devices, a narrative detailing the upgrade and its necessity is required.
10. Beneficiary-Owned Equipment
    When billing for accessories and supplies related to beneficiary-owned equipment, include a narrative that specifies the relationship to the beneficiary-owned item.
11. Custom Fabricated Orthotics
    For custom orthotics, provide a narrative that includes details about the fabrication process and unique features.
12. Extended Anticipated Discharge Dates
    If the anticipated discharge date is extended, include a narrative to explain the circumstances.
13. Modifier Overflow
    If more than four modifiers are required, use modifier 99 (overflow) as the fourth modifier and include the additional modifiers in the claim narrative.
14. Surgical Dressings
    When using modifier A9 (for dressing covering nine or more wounds), specify the number of wounds in the narrative.