Ostomy providers brace for new HCPCS codes

Tuesday, December 31, 2002

WASHINGTON – Despite provider requests for a delay, a new Medicare coding matrix for ostomy supplies appeared headed for a Jan. 1 implementation in early December.

Although the status of the coding changes had been “changing every day,” United Ostomy Association spokeswoman Linda Aukett says that the Centers for Medicare and Medicaid Services seemed to be resolute in launching the new HCPCS codes by the first of the year.

“We’ve had two meetings with CMS, but there was very little evidence that they wanted to postpone [the implementation date],” said Aukett, UOA’s chairwoman of government affairs. “Their meetings with us were nothing more than a courtesy. I’m afraid it’s a fait accompli at this point.”

CMS gave DMERC officials a Dec. 5 deadline to complete new code definitions, which will use a different methodology to classify ostomy items. Instead of labeling individual pouches and add-ons with a base code, Medicare will now have designations for pouches and add-ons together.

“So now instead of a base code for the pouch and add-on features, there will be separate codes for a pouch with a filter and lock ring, a pouch with a lock ring and comfort panel, and a pouch with a filter, lock ring and comfort panel.”

UOA lobbied CMS and Congress to delay the codes until April 1 to give secondary Medicare payers ample time to make the necessary billing changes.

“Medicare supplemental plans are notoriously slow in adopting new HCPCS codes,” Aukett said. “If they are not given time to adjust, everyone will have problems.”

Beneficiaries who file secondary claims will most likely receive denials from supplemental carriers until the codes are assimilated, she said.

Ostomy providers say it’s just the latest obstacle in a difficult market and some are wondering whether the last straw has arrived.

“It really makes us wonder if we want to continue with it,” said Gary Miller, director of Mt. Carmel Medical Equipment in Pittsburg, Kan. “This comes on top of dwindling reimbursement.”

Budget cuts at the state level, combined with manufacturer price increases are also taking a toll, added Todd Smith, marketing manager for Shield Healthcare in Valencia, Calif.

“California has taken a 2% cut and other states are even higher,” he said. “Then the two largest vendors are hiking prices by 6%. Where does that put us?”

And despite the challenges to providers, it’s the ostomy patients who will feel the brunt of it, Smith said.

“We can choose to not take assignment,” he said. “They can’t.” HME