Hi, all:
Some of us have been having private discussions about my original question
and subsequent post on the summation of responses I received.
Original question:
Can someone direct me to any information about the
following?
For Medicare patients>>>>>>>>>>>
Are Rx’s needed for replacement consumable items, i.e.,
(suspension belts such as TES or PowerBelts, socks, sheaths, suspension
sleeves, gel liners) for existing prostheses? If not, are there time limits
on how long the original Rx for the prosthesis would be eligible to use for
these consumable replacements on an ongoing basis?
And my subsequent posting:
I have received 10 responses:
* 3 responders believe that an Rx is NOT required based on information
they have received either through the AOPA Coding/Billing seminar, or from
the Local Coverage Determinations of their respective DME MAC;
* 3 responders were emphatic about getting an Rx for any and all items
no matter the circumstances;
* 3 responders are uncertain and wanted to know more information;
* 1 response was from a user who appears to be very upset that an Rx
has been required of them over many years for any item including socks.
Going through the CMS website, I have found this text in a
policy article from our DME MAC in the Northeast:
Replacement of a prosthesis or prosthetic components
required because of loss or irreparable damage may be reimbursed without a
physician’s order when it is determined that the prosthesis as originally
ordered still fills the patient’s medical needs.
Although there is no specific language regarding
“consumables”, it appears to me that this language would support issuing
replacements for consumable items for the original prosthesis without a new
Rx and no time limit. Of course, there is a “comfort zone” for each
practice and your own policies and procedures should reflect that.
Here is the link to the policy article:
http://www.cms.hhs.gov/mcd/viewarticle_pdf.asp?article_id%310&article_vers
ion &contractor_id 7
I interpret the phrase “irreparable damage” as wear and tear on a consumable
item making it no longer usable, and in an audit or review would have to
justify my billing practice of not pursuing an Rx for the replacement, but
using the original Rx for the prosthesis as the major supporting document
since it still suits the patient’s medical need, and of course my eval notes
describing the wear and tear of the items making them unusable along with
the need for replacement would be included.
Is anyone from AOPA who is on the coding committee or is familiar with the
“Billing and Coding” course reading this thread? If so, would you please
comment?
Thanks,
Eric Schwelke CPO LPO
