Urological supplies are considered necessary when patient is experiencing decreased bladder or bowel control and/or incontinence. However, Medicare does not cover incontinence supplies. Medicaid may cover them if there is an exception form on file as submitted by the patient’s physician.
The exception form acceptable by Medicaid must contain the HCPCs code. The HCPCs code submitted is determined by the size or type of item. Also to be noted is the number of items allowed per month. Once approved, the supplies are billable for up to a full year.
The HCPCs code range from T4521-T4544 and each code denote the age of the patient, type of supply, size of the supply, and whether or not it is disposable or reusable.
Medicare will cover urinary catheter and other urinary collection devices when a patient has a diagnosis of permanent incontinence.
Indwelling catheters are considered primary to urinary catheters and urinary collections devices when being reimbursed. Indwelling catheters (urethral or suprapubic catheters) are those that reside within the bladder and can be used for short or long periods of time.
External catheters (condom catheters) are those placed on the outside of the body and are typical for men. Depending on the brand supplied, daily change of external catheters may be required.
Short term catheters (intermittent catheters) are used for short periods of time, typically following surgery, until the bladder empties. There are multiple types including rubber, plastic (PV), and silicone. Short term catheters can be used within the patient’s home.
A patient is eligible for up to 2 leg bags and 2 night bags for urinary collection.
Documentation within the WOPD should state whether the patient is stationary, ambulatory or in use of a wheelchair. Coverage of the urinary supplies can depend on these factors.
The initial requirement to billing for a medically necessary commode is when the patient in a bed for the majority of their day and/is unsteady to mobilize.
A 3-in-1 commode chair is one that can function as it states, in 3 ways. It can function as a free standing bedside commode. Second it can function as a safe, elevated seat when placed over the toilet itself with a bucket removed. Finally, it can be utilized as a safety frame to use with a conventional toilet when the seat and bucket are removed.
A Standard bedside commode chair: is composed of 3 fixed components, the frame, bucket, and seat. The particular commodes can have four legs and remain stationary for maximum stability or have wheels so it can easily be removed from bedroom to bathroom.
An uplift assist commode features a mechanism to help raise the patient from a seated position to a standing position once finished.
Other optional supplies that can be necessary to provide and bill for in conjunction with commodes are
• Treated plastic, PVC plastic, aluminum, or stainless steel construction
• Folding arms and legs for easy transportation or fixed arms and legs for stability
• Fixed arms, drop arms, or slide-away arms