## Definition
Healthcare Common Procedure Coding System Code E1391 refers to the provision of a durable medical device, specifically an oxygen concentrator. Oxygen concentrators are devices that extract and purify oxygen from the surrounding air to provide supplemental oxygen therapy to individuals with respiratory difficulties. The code E1391 is utilized within the billing framework of both public and private health insurance systems to ensure uniformity in claims submission.
This particular code is part of the Level II Healthcare Common Procedure Coding System, which primarily covers medical equipment, prosthetics, orthotics, and supplies. The classification is essential for tracking the use of oxygen concentrators across the healthcare system and for the purposes of reimbursement. Code E1391 is specific to oxygen concentrators that are not portable, typically used in a patient’s home.
## Clinical Context
Oxygen concentrators addressed by Healthcare Common Procedure Coding System Code E1391 are most often prescribed for patients who suffer from chronic conditions that affect their lung function, such as chronic obstructive pulmonary disease, emphysema, or severe asthma. The device facilitates oxygen therapy, which is aimed at improving tissue oxygenation and overall pulmonary efficiency.
Physicians may recommend these non-portable oxygen concentrators for patients requiring long-term oxygen therapy, particularly for individuals who need supplemental oxygen for extended periods while at rest, but who might not require a portable solution. The use of such devices is commonly limited to home or clinical settings where mobility is not a constant consideration.
## Common Modifiers
Common billing modifiers associated with Healthcare Common Procedure Coding System Code E1391 include modifier RR, indicating that the equipment is being rented rather than purchased outright. The use of this modifier is particularly frequent, as oxygen concentrators are often rented on a monthly basis, either because of the patient’s temporary needs or because of the high cost of purchase.
Another common modifier is modifier NU, which denotes that the equipment has been purchased, as opposed to being rented. Additionally, the modifier UE, which represents the designation of equipment as “used,” may be applied in cases where the oxygen concentrator is not new at the time of dispensing but is still considered to be in fully functional condition.
## Documentation Requirements
To successfully claim reimbursement for Healthcare Common Procedure Coding System Code E1391, healthcare providers must maintain detailed documentation. This should include a prescription from a licensed healthcare provider, specifically outlining the medical necessity for long-term oxygen therapy. Additionally, thorough medical records should correlate the patient’s diagnosis with the need for supplemental oxygen, including the results of blood gas studies or pulse oximetry.
The documentation must also explicitly state that the patient requires the use of a non-portable oxygen concentrator for in-home use. It is crucial to provide specific details about the duration and frequency of oxygen use prescribed by the healthcare provider. Without meeting these documentation requirements, reimbursement claims may be subject to denial.
## Common Denial Reasons
Denials for Healthcare Common Procedure Coding System Code E1391 claims often occur due to insufficient or missing documentation supporting the medical necessity of the oxygen concentrator. Specifically, the lack of a valid prescription or failure to provide proper clinical justification, such as evidence of hypoxemia or poor lung function, can lead to claim rejection.
Another frequent reason for denial is the misuse of billing modifiers, particularly in situations where the equipment rental status is incorrectly coded. Additionally, denials may arise if the patient does not meet the coverage criteria as stipulated by the payer, often related to discrepancies in the diagnosis or a failure to meet the clinical thresholds for oxygen therapy.
## Special Considerations for Commercial Insurers
Commercial insurance providers may have specific policies in place for rental versus purchase agreements pertaining to durable medical equipment like oxygen concentrators. Some insurers impose stricter limitations on rental periods and may require additional documentation to extend payments beyond a certain timeframe. It is not uncommon for commercial insurers to request a re-evaluation of a patient’s condition periodically to confirm the continued medical necessity for the equipment.
Moreover, certain commercial payers may not offer coverage for used equipment or may enforce higher copayment obligations when patients opt for oxygen concentrators with additional features that are deemed non-essential. Thus, it is imperative for healthcare providers and patients alike to thoroughly review an insurer’s durable medical equipment policy before dispensing oxygen concentrators.
## Similar Codes
Healthcare Common Procedure Coding System Code E1390 is a similar code that also pertains to oxygen concentrators but differs from E1391 principally in that E1390 describes a portable oxygen concentrator instead of the non-portable type. E1390 is typically used when patients require oxygen therapy outside of their home or in settings that require greater mobility, such as during travel.
Additionally, Healthcare Common Procedure Coding System Code K0738 covers humidification systems used in conjunction with oxygen concentrator units, providing an accessory that adds moisture to the oxygen output to prevent dryness in the airways. While related to oxygen therapy, K0738 is used to describe a specific component, rather than the concentrator itself.