Getting the Intermittent Catheter the Patient Needs: Considerations in Coding, Coverage and Documentation

Background:  Nurses with knowledge of catheter features, the Healthcare Common Procedural Coding System (HCPCS), reimbursement guidelines, and proper documentation have the essential information needed to ensure that patients performing intermittent self-catheterization receive the best product for their individualized needs.

Objectives:   Urologic nurses and associates invest a notable amount of time educating patients who need to self catheterize.   Some of this time is spent helping the patient accept the need and increase their comfort level in performing the procedure.  Time is also spent selecting the optimal product(s) for the patient’s needs to effectively manage their condition. Patient comfort,  preference, compliance, and clinical outcomes are all critical considerations for clinicians. Product features, such as a hydrophilic coating or a Coudé tip for intermittent catheters (IC), play a significant part in the selection of the right products for the patient. 

Additionally, catheter reimbursement guidelines often dictate which products are available and what steps health care providers can take to ensure patients get the best product to fit their needs.  Wherever the brand or type of catheter you and your patient selected is not specified on the prescription, such as “hydrophilic coated,” suppliers can substitute the brand they choose, including lower quality products that cost the supplier less yet the patient pays the exact same copay out-of-pocket.

Methods:   Understanding reimbursement will enable clinicians to help the patient select the best intermittent catheter for their clinical needs that is also covered by their insurance at home, while avoiding additional documentation needs and/or product supply issues.

 

Results: Not a study.

Conclusions:

*         Clinicians will gain the knowledge to help ensure patients get the catheter they need, such as: proper documentation for reimbursement and how to indicate the specific catheter choice on the prescription.

*         Patient compliance is key to a successful bladder management program, and a catheter that is preferred by the patient and easy-to-use can increase long-term compliance.  (Chartier-Kastler)

*         For IC users, increased compliance with their prescribed catheter regimen leads to better outcomes    

(Newman, et al 2011) and a reduction in urinary tract infections (UTI’s) (Cardenas et al 2011). 

*         There is no single catheter that is best for every patient. There are different materials, coatings, 

design of  tips, eyelet shape and quality, size, flexibility, lubrication process and/or packaging.

*         Catheter choice should be based on the clinical assessment and patient choice.

*         ICs are reimbursed the same, meaning the more technologically advanced catheters, such as hydrophilic coated ICs, cost the exact same dollars to the health system and to the patient as standard ICs, such as uncoated catheters that require additional lubricant cost.