Codapedia is now a division of Find-A-Code

Documentation for Urological Supplies

March 9th, 2018 - Medicare Learning Network
Categories:   Documentation Guidelines   DME|Supplies|Equipment   Medicare  
0 Votes - Sign in to vote or comment.

The Medicare Learning Network provides guidance on required documentation for urological supplies.

For DME items, you must meet the following requirements:

  1. Prescription (orders)
  2. Medical Record Information (including continued need/use if applicable)
  3. Correct Coding
  4. Proof of Delivery (Suppliers are required to maintain proof of delivery documentation files)
  5. The supplier must receive a Detailed Written Order before a claim is submitted

You must meet specific criteria for urological supplies to qualify for payment.

  • The patient must have permanent urinary retention or urinary incontinence. This is defined as retention that is not expected to be corrected within 3 months either medically or surgically (this includes supplies billed in a physician’s office). Urological supplies will not be covered in patients with temporary conditions.
  • Medicare will only cover related supplies necessary for proper use if the catheter or external urinary collection device meets the coverage criteria.
  • Medicare covers only one Indwelling Catheter (A4311-A4316, A4338-A4346) per month for routine catheter maintenance. Medicare only covers non-routine catheter changes under medical necessity. Documentation must show medical necessity for the following indications
    • Catheter is accidentally removed
    • Malfunction of catheter
    • Catheter is obstructed
    • History of urinary tract infection or recurring obstruction that requires a schedule change frequency of more than once per month
  • Medicare only covers one Catheter Insertion Tray (A4310-A4316, A4353, and A4354) per episode of insertion.
  • Medicare only covers Intermittent Irrigation of an Indwelling Catheter supplies on a non-routine basis when there is an acute obstruction in the catheter.
  • Medicare covers Continuous Irrigation of Indwelling Catheters when a history of obstruction and patency cannot be maintained with intermittent irrigation and catheter changes.
  • Intermittent catheterization is covered when basic coverage criteria are met and the beneficiary or caregiver can perform the procedure.
    • Additional coverage criteria for sterile intermittent catheter kit includes:
      • Resides in a nursing facility
      • Immunosuppressed
      • Documented vesico-ureteral reflux while on a program of intermittent catheterization
      • Spinal cord injured pregnant female with neurogenic bladder
      • Recurrent UTIs twice within 12 months prior to initiation of sterile intermittent catheter kits
  • Medicare covers External Catheters/Urinary Collection Devices female or male external urinary collection devices as an alternative to an indwelling catheter for patients who have permanent urinary incontinence.
    • Male external catheters should not exceed a quantity of 35/month (A4349)
    • Female external collection devices should not exceed more than one meatal cup (A4327) per week or one pouch (A4328) per day

For a specific list of covered supplies for the above mentioned catheter types, please refer to LCD L33803.

  • Refills. Suppliers must contact the patient prior to dispensing the refill (contact should be no sooner than 14 calendar days prior to the delivery/shipping date). Refills must deliver the DMEPOS product no sooner than 10 calendar days prior to the end of usage of the current product. Suppliers cannot deliver refills without a beneficiary request.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Q/A: How Many Diagnosis Codes do I use?
April 15th, 2019 - Wyn Staheli, Director of Research
Question: My patient has a lot of chronic conditions. Do I need to include all these on the claim? I know that I can have up to 12 diagnoses codes on a single claim. What if I need more than that? Answer: More is not always better. You only need to ...
Watch out for People-Related ‘Gotchas’
April 15th, 2019 - Wyn Staheli, Director of Research
In Chapter 3 — Compliance of the ChiroCode DeskBook, we warn about the dangers of disgruntled people (pages 172-173). Even if we think that we are a wonderful healthcare provider and office, there are those individuals who can and will create problems. As frustrating as it may be, there are ...
Q/A: What do I do When a Medicare Patient Refuses to Sign an ABN?
April 8th, 2019 - Wyn Staheli, Director of Research
Question: What do I do when a Medicare patient refuses to sign an ABN? Answer: That depends on whether the patient is still demanding to have/receive the service/supply. If they aren’t demanding the service, then there is no need to force the issue. Just make sure that you still have an ...
Prepayment Review Battle Plan
April 8th, 2019 - Wyn Staheli, Director of Research
Any type of payer review can create some headaches for providers and cause problems for a healthcare office. Even for a practice that has taken administrative steps to try and prevent a prepayment review, it can still happen. A prepayment review means that you must include documentation WITH your claim. ...
Looking Ahead - Changes in Dentistry!
April 3rd, 2019 - Christine Taxin
In the next 10 years, what is the biggest change dentistry will experience? FW: We all know healthcare in the U.S. is changing rapidly. Dentistry is no exception. My opinion is that several big changes are forthcoming. Most often, I think about changes that benefit patients and/or providers. Here are three ...
Q/A: I Submitted a Claim to the VA and it’s Being Denied. Why?
April 1st, 2019 - Wyn Staheli, Director of Research
I submitted a claim to the VA and it’s being denied. Why? There are several reasons why your claim might be denied by the Veterans Administration (VA). However, without more information about the claim itself (e.g., services billed), we can only provide the following general information about the VA and chiropractic ...
Corrections and Updates
April 1st, 2019 - Wyn Staheli, Director of Research
One constant in our industry is change. Policies change, contracts change, and there are updates. Also, people aren’t perfect and mistakes can be made. So this article will cover a variety of topics. Published Articles We appreciate feedback from our valued customers. We have received feedback regarding two of our articles which ...



About Codapedia & Find-A-Code Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™/Find-A-Code™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2019 Find A Code, LLC - CPT® copyright American Medical Association