Denise Posted Thu 24th of July, 2014 17:07:36 PM
During a cysto with a very complicated foley catheter insertion we used a "supply tray for obstructed urethra" which cost $389. The Medicare reimbursement for this tray is only $16.11! Even with the office visit reimbursement $100.23 for 99214(the dr spent over 30 minutes with the patient in the room before deciding to take him to the cysto suite) and $185.90 for cysto (complicated foley insertion is bundled in the cysto) we still lose over $100 on the cost of the tray. We did verify with our supply company that this was the correct code for the supply tray A4311. Is there any way to recoup this cost? A different way of coding the office visit/procedure? Any ideas would be appreciated.
SuperCoder Answered Fri 25th of July, 2014 09:03:46 AM
Thanks for your question. I am working on an answer for you. Please allow a little more time.
SuperCoder Answered Sun 27th of July, 2014 23:36:50 PM
Your coding appears correct. The DME payments rarely meet the cost of some of these products so many offices do not purchase these expensive kits. Unfortunately, there is no coding change available to make up for the expense charges.
Also, just a reminder ... As you probably know, the catheter expense is only paid if the condition is chronic (i.e., 3 months or longer). I am unable to tell if that is the case in your clinical scenario.
I hope this helps.
Leesa A. Israel, BA, CPC, CUC, CPPM, CMBS
Executive Editor, The Coding Institute
Editor, Urology Coding Alert and Practice Management Alert
Audit Manager - Training, TCI Consulting & Revenue Cycle Solutions