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| Enteral Nutrition Supply Kits Suppliers are reminded that supply kits used for the administration of enteral nutrition must match with the route of administration. The Enteral Nutrition LCD Indications and Limitations of Coverage and/or Medical Necessity sections states: The feeding supply kit (B4034-B4036) must correspond to the method of administration indicated in question 5 of the DME Information Form (DIF). If it does not correspond, payment for the billed code will be based on the allowance for the code relating to the method of administration specified on the DIF or the billed code, whichever is less. If a pump supply kit (B4035) is ordered and the medical necessity of the pump is not documented, payment will be based on the allowance for the least costly medically appropriate alternative, B4036. The codes for feeding supply kits (B4034-B4036) are specific to the route of administration. Claims for more than one type of kit code delivered on the same date or provided on an ongoing basis will be denied as not medically necessary. Usually there are not changes in the method of administration. It would therefore be unusual to see claims for differing supply codes. In the event of a modification in the route of administration, there should be information in the medical record to justify the change. However, only one supply code per day is allowed. When billing supply kit codes, suppliers are reminded that the fees for these codes are all-inclusive. It is inappropriate to unbundle and bill separately for these items. The Coding Guidelines section of the Enteral Nutrition Policy Article states: The codes for enteral feeding supplies (B4034-B4036) include all supplies, other than the feeding tube itself, required for the administration of enteral nutrients to the patient for one day. Codes B4034-B4036 describe a daily supply fee rather than a specifically defined kit . Some items are changed daily; others may be used for multiple days. Items included in these codes are not limited to pre-packaged kits bundled by manufacturers or distributors. These supplies include, but are not limited to, feeding bag/container, flushing solution bag/container, administration set tubing, extension tubing, feeding/flushing syringes, gastrostomy tube holder, dressings (any type) used for gastrostomy tube site, tape (to secure tube or dressings), Y connector, adapter, gastric pressure relief valve, declogging device, etc. These items must not be separately billed using the miscellaneous code (B9998) or using specific codes for dressings or tape. The use of individual items may differ from patient to patient and from day to day. Only one unit of service may be billed for any one day. Units of service in excess of one per day will be rejected as incorrect coding. Refer to the Enteral Nutrition LCD and Policy Article for additional information on the coverage and billing of supplies. |
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