Documentation for Urological Supplies

by  Medicare Learning Network
March 9th, 2018

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.

References:

Documentation for Urological Supplies. (2018, March 9). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/documentation-for-urological-supplies-33510.html

© InnoviHealth Systems Inc

Article Tags  (click on a tag to see related articles)


Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please Contact Us.


contact

innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)
Email:
free demo
request yours today
pricing
for any budget
sign IN
welcome back!

Thank you for choosing Find-A-Code, please Sign In to remove ads.