Coding chaos?

Thursday, October 31, 2002

IRVINE, Calif. - Just five months after getting new, more generous ostomy codes in April, providers began to hear disturbing news: Another set of ostomy coding changes may be on the way from CMS.

"It looks like they plan to eliminate the six pay codes they established in April for features of pouches and issue new codes that categorize pouches by which features they have specifically," said Linda Aukett, chairwoman of government affairs for the Irvine, Calif.-based United Ostomy Association (UOA).

Worst case scenario, she says, CMS may establish a matrix system to assign a unique code for every conceivable permutation of pouch features. Aukett estimates that such a move could add upward of 70 new codes to the mix, which she described as "unwieldy and cumbersome."

As of the editorial close of this issue of HME News, UOA was developing a response to the proposed ostomy changes and was trying to schedule a conference call with CMS officials.

One of the fears is that a matrix coding system may result in a decrease in reimbursement for pouches with no special features. But Aukett noted that a sizable number of ostomy patients still use "plain vanilla pouches."

"I just don't understand the need for change again," said Patti Langenbach, president of the Jacksonville, Fla.-based Medical Care Products, which specializes in ostomy supplies. "[CMS] did something for the first time with ostomy supplies that was very positive. So now we're getting back to where most companies - at least in mail order - can afford to take assignment and gives consumers a larger field of products and providers to choose from to suit their exact needs. If they go backward on this, I think it would be just awful." HME