LCD Reference Article Response To Comments Article

Response to Comments: Urological Supplies (DL33803)

A58231

Expand All | Collapse All
Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A58231
Original ICD-9 Article ID
Not Applicable
Article Title
Response to Comments: Urological Supplies (DL33803)
Article Type
Response to Comments
Original Effective Date
06/11/2020
Revision Effective Date
N/A
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

N/A

Article Guidance

Article Text

During the 45-day comment period the DME MACs received a total of seven comments: five comments were received from treating practitioners, one comment from a supplier, and one comment from a supplier association.

Introduction to Responses

The DME MACs appreciate the comments received from stakeholders during the open comment period on this proposed Urological Supplies Local Coverage Determination (LCD).

Pursuant to the CMS Program Integrity Manual (CMS Pub. 100-08) Chapter 13, the final policy and our response to comments are based on general acceptance by the medical community, as evidenced by published original research in peer-reviewed medical journals, systematic reviews and meta-analyses, evidence-based consensus statements and clinical guidelines.

Response To Comments

Number Comment Response
1

One commenter submitted a request for additional clarifying language about when new orders are required in the Urological Supplies Policy Article (PA).

The comment is outside of the scope of this LCD reconsideration. Details regarding orders may be found in the Standard Documentation Requirements PA (A55426).

2

Four commenters submitted comments which endorsed coverage of the inFlow™ device. One commenter endorsed coverage of the inFlow device as an alternative to intermittent catheterization to improve quality of life, safety and dignity of women with PUR.

The final LCD has been published as it was proposed.

3

Several commenters suggested that inFlow coverage should include patients using indwelling, or suprapubic catheters.

The final LCD is based on the best currently available clinical literature, however the available evidence on patients using indwelling and suprapubic catheters is of lower quality. The commenters did not provide any additional clinical evidence to support their suggestion.

4

Several commenters requested that Medicare coverage extend to all women who have PUR, with broader language related to cause or based on having symptoms of PUR.

The commenters did not provide any clinical literature to support their suggestion. The final LCD is based on the best currently available literature.

5

One commenter requested that information in a retired DME MAC article regarding utilization of intermittent urinary catheters be included in the updated LCD.

The comment is outside the scope of this LCD reconsideration.

6

One practitioner commented that the policy should be revised to allow for more than one inFlow device every 29 days to allow for situations where the beneficiary must remove the device, such as for an MRI.

The inFlow Instructions for Use indicate replacement every 29 days. In the event of a situation where the beneficiary must remove the device prior to the routine replacement date, such claims may be considered upon appeal.

7

One commenter noted that the documentation requirements for continued coverage after 90-days were unclear.

As noted in the LCD, the purpose of the 90-day evaluation is to establish that the beneficiary’s urinary symptoms have improved, and the beneficiary is adherent to the usage of the inFlow device. The LCD language is deliberately not proscriptive on how a treating practitioner documents these two elements.

8

Two commenters raised concern about being unable to properly code for PUR due to IDC as no ICD-10 exists.

There are no specific ICD-10 codes applicable to the inFlow device. Since ICD-10 codes are not contained in the LCD, these comments are outside the scope of this LCD reconsideration.

N/A

Coding Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L33803 - Urological Supplies
Related National Coverage Documents
N/A
SAD Process URL 1
N/A
SAD Process URL 2
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
06/05/2020 06/11/2020 - N/A Currently in Effect You are here

Keywords

  • N/A