New ostomy codes could be in jeopardy
WASHINGTON - Whether the much-heralded, new ostomy codes should include six add-on codes for pouches is up for debate, CMS told the United Ostomy Association (UOA) last month.
CMS has asked the DMERC medical directors to take a second look at the new codes and fees, and the Irvine, Calif.-based UOA, which has worked with the agency since last year to shape the new codes, requested a meeting with CMS to find out why.
Linda Aukett, UOA's chairwoman of government affairs, said CMS fears the way the new codes and fees are structured, it's paying twice for features like odor barriers, which are now add-on codes. CMS believes that when the fee schedule for ostomy codes was created in the late 1980s many of those features might already have been included in the codes.
"They're saying when you buy a suit coat, you pay for it once," Aukett said. "You don't pay again for the sleeve."
Aukett said the UOA doesn't agree with CMS's analogy.
Features like odor barriers were much less prevalent when the fee schedule for ostomy codes was created, Aukett said. At that time, only a small percentage of pouches under a code would include such features. Today, pouches are commonly outfitted with features like filters, rustle-free barriers, comfort panels, faucet-type taps and flange-locking mechanisms.
"Yet the fees don't adequately reflect that," Aukett said.
Which is one of the reasons why the UOA had lobbied CMS to break out those features and give them their own codes. The add-on codes enabled providers to get anywhere from 28 cents to 46 cents more in reimbursement, which, in turn, increased the number of products providers could take assignment for.
Patti Langenbach, president of the Jacksonville, Fla.-based Medical Care Products, agrees with the UOA. She said under the old codes a basic pouch like the one-piece pouch with skin barrier is reimbursed the same as a pouch with skin barrier, odor barrier, rustle-free barrier and comfort panel.
"It was like getting the same money for a Hugo and a Lexus," she said. "And people couldn't get the products that make their life so much easier because of it."
Langenbach said the new codes have allowed her company to increase the ostomy products it takes assignment on by almost 5% to 99% of all products.
Aukett said CMS asked the UOA to submit comparative information about the prevalence of the features in the late 1980s and today before the end of last month to help the agency make its decision.
A CMS official would only say that the agency met with the UOA regarding concerns it was with the add-on codes for pouches. He said CMS would review the codes at the next HCPCS Workgroup meeting on July 16. HME