| NHIC, Corp.DME MAC A ListServe | For Immediate Release |
| May 29, 2009 Ostomy Supplies - Billing ReminderA recent review of claims for ostomy supplies by the DME MAC Jurisdiction A, Medical Review, has identified billing discrepancies. This article is intended to serve as a reminder of the key policy elements.Ostomy supplies are covered for use on patients with a surgically created opening (stoma) to divert urine or fecal contents outside the body. Ostomy supplies are appropriately used for colostomies 569.60, 569.62, V44.3, V55.3, ileostomies V44.2, V55.2 or urinary ostomies V44.6, V55.6. Use for other conditions will be denied as noncovered. The quantity of ostomy supplies needed by a patient is determined to a great extent by the type of ostomy, its location, its construction, and the condition of the skin surface surrounding the stoma.Suppliers are reminded that the provisions of ostomy supplies should be limited to a one-month supply for patients residing in a nursing facility and a three-months supply for patients at home. Ostomy supplies are not separately payable when a patient is in a covered home health episode. Ostomy supplies must be provided by the home health agency and payment is included in the home health Medicare payment rate. It is not appropriate to bill these to the DME MAC.For supplies billed in a home setting, the following processing guidelines will apply:If there is no indication of the number of months the supplier is billing for we will allow up to a 3-month supply.If there is indication on the claim of the number of months being billed, we will process as billed, up to a 3-month supply.An order for each item billed must be signed and dated by the treating physician, kept on file by the supplier, and be available upon request. Items billed before a signed and dated order has been received by the supplier must be submitted with an EY modifier added to each affected HCPCS code. Suppliers must maintain the preliminary written order and this documentation must be available to the DME MACs upon request. If the supplier does not have an order from the treating physician before dispensing an item, the item is noncovered.For detailed written orders, the following elements must be present:Beneficiary's nameDescription of the itemTreating physician's nameStart date of the order (if different from physician's signature date)For ostomy supplies or any item that is dispensed on a periodic basis, the detailed written order must also include:Quantity to be dispensedFrequency of changeLength or duration of treatmentIn order to prevent denials, and submitting claims with overlapping dates of service, the claims must reflect the correct date the supplies are disbursed.It is important for suppliers to be familiar with the documentation requirements and utilization parameters as outlined in the Ostomy Supplies LCD L11502 and policy article. Suppliers can review the LCD and policy article on the DME MAC A Web site at: http://www.medicarenhic.com/dme/medical_review/mr_lcd_current.shtml |
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