From North Central Oklahoma Ostomy Outlook September 2013:
Documentation your Doctor needs to provide for your Supplies
by James Knight,
Knight Medical Supply LLC
These are notes that James Knight handed out during his presentation at our
meeting in Stillwater on Aug 19, 2013.
- Ostomy supplies are not separately payable when a
Medicare beneficiary 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.
- Supplier-produced records, even if signed by the
ordering physician, and attestation letters (e.g. letters
of medical necessity) are deemed not to be part of a
medical record for Medicare payment purposes.
- Information contained directly in the contemporaneous
medical record is the source required to justify
payment except as noted elsewhere for prescriptions
and CMNs (Certificates of Medical Necessity). The
medical record is not limited to physician’s office
records but may include records from hospitals, nursing
facilities, home health agencies, other healthcare
professionals, etc.
- Example of information needed: type of
ostomy, its location, its construction, and
condition of skin surrounding the stoma.
- When supplies used are greater than the usual
maximum quantity listed in the Indications and
Limitations of Coverage and/or Medical Necessity
section, there must be adequate, clear documentation
in the beneficiary’s medical records corroborating the
medical necessity of this amount.
- For items that the beneficiary obtains in-person at a
retail store, the signed delivery slip or a copy of the
itemized sales receipt is sufficient documentation of a
request for refill.
- For items that are delivered to the beneficiary,
documentation of a request for refill must be either a
written document received from the beneficiary or a
contemporaneous written record of a phone
conversation/contact between the supplier and
beneficiary. Suppliers must contact the beneficiary
prior to dispensing the refill and not automatically
ship on a pre-determined basis, even if authorized by
the beneficiary.
- The order must include the type(s) of supplies
ordered and the approximate quantity to be used per
unit of time. A new order is required if there is an
increase in the quantity of the supply used per month
and/or the type of supply used.
- Signature and date stamps are not allowed.
- Frequency of use information on orders must contain
detailed instructions for use and specific amounts to
be dispensed. Orders that only state “PRN” or “as
needed” utilization estimates for replacement
frequency, use, or consumption are not acceptable.
- The detailed description in the written order may be
either a narrative description or a brand name/model
number.
- A routine refill prescription is not needed as long as
the physician specified length of need is lifetime. A
new prescription is needed when:
- There is a change of supplier
- There is a change in the item(s), frequency of
use, or amount prescribed
- There is a change in the length of need or a
previously established length of need expires
- State law requires a prescription renewal
- ICD-9 (Diagnostic) Codes that are Covered
- 569.60 - Colostomy and Enterostomy
Complication Unspecified
- 569.92 - Mechanical Complication of
Colostomy and Enterostomy
- V44.2 - Ileostomy Status
- V44.3 - Colostomy Status
- V44.6 - Status of other Artificial Opening of
Urinary Tract
- V55.2 - Attention to Ileostomy
- V55.3 - Attention to Colostomy
- V55.6 - Attention to Other Artificial Opening
of Urinary Tract
Name:
Date:
ICD-9 Code(s):
Detailed Description of the Item(s):
Item:
Quantity to be Dispensed:
Frequency of Use:
Length of Need:
Item:
Quantity to be Dispensed:
Frequency of Use:
Length of Need:
Physician Name:
Physician Signature:
Date:
DETAILED WRITTEN ORDERS
- Beneficiary’s name
- Physician’s name
- Date of the order and the start date, if start date is
different from the date of the order
- Detailed description of the item(s) (see below for
specific requirements for selected items)
- Physician signature and signature date
- Item(s) to be dispensed
- Frequency of use
- Quantity to be dispensed
- Number of refills
Back to North Central Oklahoma Ostomy Newsletter Index
This page last revised 2013-09-17
This article appeared in the North Central Oklahoma newsletter Ostomy Outlook.
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