Urology Times
Q
Can we bill Medicare patients for catheters as durable medical equipment (DME)? Specifically, can we use codes A4351, A5112, and A4338 when billed alone or with specific procedures such as 51701, 51702, and 51703? I cannot get a straight answer. I have been told, “Yes, with an advanced beneficiary notice (ABN) signed,” “Yes, you don’t have to an ABN signed,” and, “No, you cannot charge Medicare patients for these.” Please advise.
A
The answer is unequivocally no, you cannot charge Medicare for the catheter when billing for a catheter insertion. The cost of the catheter is included in the practice expense portion of your payment for the insertion. You cannot charge with or without an ABN. A charge for the catheter would, in essence, be double-charging Medicare.
If a urologist inserts the catheter in the hospital, emergency room, etc., the Medicare national average payment is $30.92. If the catheter is inserted in the office, the national average payment is $77.13. The difference in payment is meant to cover the catheter, supplies, office rent, etc.
That being said, the carriers were probably thinking of “catheters for home use.” If you give a catheter to a patient to use at home, you can charge for the catheter. If this is a patient with chronic incontinence, DME can be charged without an ABN. If you are charging for DME, you will need to have a supplier number and charge this to the durable medical equipment regional carrier. If this is not a chronic incontinence problem, then the patient can be charged, and we would suggest using an ABN.
Let us repeat: This is not for a catheter you inserted that will be used at home; this is for a catheter given to the patient to use at home and for which there was no insertion performed or charged.
Q
I understand that payment rules for multiple procedure reduction have been changed for urodynamics. Is this correct, and should I change the way I am billing for urodynamics services?
A
You are correct; the multiple procedure rules for urodynamics codes were changed in October 2010. Under the new rules, the 50% reduction applied to the global and professional components will now also be applied to the technical component. Previously, the technical component, if reported with a –TC modifier, was not subject to multiple procedure reductions.
At this point, payment will be the same whether you bill the procedure as a global service or you charge the technical component and professional components separately, even if they are reported by two different providers.
Should you change the way you are billing? In short, no. We have always and will continue to recommend that you report the services that you provide accurately.
Therefore, if your office has a day in which the technical portion of the urodynamics is provided for many patients and those patients are scheduled for a return visit with the physician who is responsible for the professional interpretation of the tests, you should continue to bill the technical component (codes with a –TC) on the day of the test and the professional component (same codes with –26) on the day of the visit with the physician. Remember to follow the “incident to” rules and list the billing provider as the person in the office on the day the service was provided.
If the test and interpretation are provided on the same date, bill the global service with no modifiers.
A quick side note for urodynamics: The values assigned to the uroflow (51741) have been reduced for 2011. Your payments will be down almost 72% in total for this service. The remaining urodynamics codes that are commonly billed remained relatively the same.
Q
Please provide guidance and supporting references to the documentation requirement for an automated urinalysis. Some of our practices hand-write the UA results into the chart instead of affixing the printout to the chart, stating the print/paper quality fades over time. Please advise.
A
We cannot find and have not found in the past any requirements for inclusion of the printout in the medical record for automated UA.
In the absence of specific requirements, we recommend that all information be recorded in the patient chart as a result of the test. Each office compliance protocol must address the issue of what is required to accomplish this. The paper used by the machines is often problematic for retaining long-term image quality. Likewise, it is not always plausible to add a printout from a machine to the electronic medical record.
At a minimum, we recommend clearly recording the results of the test in the medical record, with a note as to which machine was used to provide the results. This can be done in either print or electronic record, with a template indicating the machine used as well as a space for recording the results. The image may be retained as an additional record or as the record of the test and results, but the integrity of the image will need to survive at least 5 years and possibly as long as 7 years under current requirements for medical record retention. In other words, you do not have to include the printout, but it is a good idea, even if you record the results elsewhere.
The larger issue we have seen in audits for UA is not related to the provision of the service, but the question of whether the procedure was “medically necessary.” Therefore, we advise that any UA, regardless of type, be supported clearly by medical need.
