January 19, 2017
DME Information Forms (DIFs) Usage for Enteral and Parenteral Nutrition and External Infusion Pumps - Revised
Joint DME MAC Publication
This article was originally published in January 2015, republished in June 2015. The June 2015 revision reflected that external infusion pumps do not require a recertification DIF when the length of need expires and the ordering physician extends the length of need. A revised DIF is the proper form for the supplier to complete. This January 2017 revision corrects a clerical error that at the end of the article inadvertently left the instructions for suppliers to obtain a recertification DIF when length of need expires and the ordering physician extends the length of need.
The DME MACs use DME Information Forms (DIF) when processing claims to assure the most current information is on file and to allow the claims to pay correctly. Claims for enteral and parenteral nutrition and external infusion pumps require a DIF to be submitted with the initial claim as well as when changes in the items or quantities provided are made. DIFs are completed entirely by the supplier and do not need to be signed by the treating physician. DIFs are required to be signed and dated by the supplier.
The following table indicates the DIFs for external infusion pumps and enteral/parenteral nutrition.
DME MAC FORM CMS FORM ITEMS ADDRESSED
|09.03||10125||External Infusion Pumps|
|10.03||10126||Enteral and Parenteral Nutrition|
A new Initial DIF is required when:
- An enteral formula billed with a different code, which has not been previously certified, is ordered; or,
- For either enteral formulas or administration via pump (B9000 or B9002), there has been a break in billing of more than 60 days (plus the remaining days in the rental month) and there has been a change in the underlying medical condition that justifies coverage for the item(s).
- A beneficiary receiving enteral nutrition by the syringe or gravity method is changed to administration using a pump* (B9000 or B9002).
*Change in method of administration from gravity or syringe to a pump (B9000 or B9002) requires a new initial DIF for the pump and a revised DIF for the enteral nutrient (See chart below).
A Revised DIF is required when there has been a change in any of the information recorded on the DIF. The table below lists changes that require a Revised DIF to be submitted:
|External Infusion Pumps||Changes in the existing drug HCPCS code
Substitution of drug HCPCS code for existing drug HCPCS code
Addition of drug HCPCS code
Change in the route of administration
Change in method of administration
Extend expired length of need
|Enteral and Parenteral Nutrition||Change in HCPCS code for the current nutrient provided
Change (increase or decrease) in the calories prescribed
Change in the method of administration from gravity to syringe or syringe to gravity (See above for gravity or syringe to pump)
Change in the number of days per week of administration
Change in route of administration from tube feedings to oral feedings (if billing for denial)
For additional information, refer to the Supplier Manual located at http://www.cgsmedicare.com/jc/pubs/supman/index.html, and the applicable Local Coverage Determination, and related Policy Article.