Charlene Posted Mon 24th of February, 2020 15:41:00 PM
Physician performed an I&D with drain & bulb placement for a seroma (office setting). The patient is not in a global from a prior procedure. The physician wants to know if the drain & bulb apparatus can be billed in addition to the I&D or is it included in the procedure. Please direct us to the current documentation/guidelines regarding this for our physician. The patient has Medicare. Where are the guidelines for surgical supplies that were left in place for an x-amount of days. Is this a billable DME?
SuperCoder Answered Tue 25th of February, 2020 01:50:24 AM
Thanks for your question.
A bulb with a drainage port is a part of a collection device to remove fluid. So, these are not reported separately. We need to code only for I&D of seroma.
Please feel free to write if you have any question.
Charlene Posted Tue 25th of February, 2020 10:13:13 AM
Just to clarify what you said, you cannot bill for the catheter/bulb device as it is a drainage device and is included in the procedure. Can you point me to the Medicare manual regarding this policy? My physician will need to see this in black and white. Thank you.
SuperCoder Answered Wed 26th of February, 2020 02:58:13 AM
As we know, an MUE for a HCPCS/CPT code is the maximum number of units of service (UOS) under most circumstances allowable by the same provider for the same beneficiary on the same date of service. MUE of code for bulb supply (e.g. A4320) is “0” for Practitioner Services in Medicare. Moreover, Medicare has assigned a fee of $0.00 for this code. This means Medicare will not pay for this supply separately.
As per CMS, “The MUE value for a code may be “0” because the code is listed as invalid, not covered, bundled, not separately payable, statutorily excluded, not reasonable and necessary, etc…” and “Non-drug-related HCPCS/CPT codes may be assigned an MUE of 0 for a variety of reasons including, but not limited to, outpatient hospital MUE value for surgical procedure only performed as an inpatient procedure, noncovered service, bundled service, or packaged service…”
For more information, please read Chapter1 General Correct Coding Policies Final pdf
Hope this helps.
Charlene Posted Wed 26th of February, 2020 07:21:06 AM
Yes, thank you so much :)
SuperCoder Answered Thu 27th of February, 2020 01:37:46 AM
You are most welcome.