Documentation Tips for Ostomy Supplies

March 8th, 2018 - Medicare Learning Network
Categories:   Documentation Guidelines   Denials & Denial Management  

The Medicare Learning Network provides guidance on essential documentation elements required to prevent denials for ostomy supplies:

To Prevent Denials
Include the following elements in submitted documentation:
1. Dispensing order description of the item
  • Beneficiary name
  • Prescribing physician name
  • Date of the order and the start date, if the start date is different from the date of the order
  • Physician signature (if a written order) or supplier signature (if verbal)
2. Detailed Written Order (DWO)
  • Beneficiary name
  • Physician 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)
  • Physician signature and signature date

3. Beneficiary Authorization

4. Refill Requirements
  • A routine refill prescription is not needed; 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)
5. Proof of Delivery (POD) 
  • Suppliers are required to maintain POD documentation in their files
6. Evidence of continued medical need
  • Initial justification for the medical need is established at the time the item(s) are first ordered
7. Evidence of continued use
  • Continued use describes the ongoing utilization of supplies or a rental item by a beneficiary
The following reminders will help you comply with Medicare ostomy supply coverage requirements:
  1. Medical records must contain adequate, clear documentation that corroborates the medical necessity of the amount ordered and billed.
  2. Ostomy supplies are not separately payable when a beneficiary is in a covered home health episode. The home health agency must provide the ostomy supplies, and payment is included in the home health Medicare payment rate.


Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.

Latest articles:  (any category)

Artificial Intelligence in Healthcare - A Medical Coder's Perspective
December 26th, 2023 - Aimee Wilcox
We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities? 
Specialization: Your Advantage as a Medical Coding Contractor
December 22nd, 2023 - Find-A-Code
Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.
ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)
December 19th, 2023 - Aimee Wilcox
Chronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.
Changes to COVID-19 Vaccines Strike Again
December 12th, 2023 - Aimee Wilcox
According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Updated ICD-10-CM Codes for Appendicitis
November 14th, 2023 - Aimee Wilcox
With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.
COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....

Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association