DME MAC Joint Publication
A recent analysis of HCPCS code A4421 (OSTOMY SUPPLY; MISCELLANEOUS) revealed that 69% of the claim lines submitted were incorrectly coded. Correct coding requires the use of a specific HCPCS code for Medicare billing when a specific code exists that appropriately describes the item provided. Use of a miscellaneous or NOC (not otherwise classified) code for billing when a specific code exists is incorrect coding. The most common incorrectly coded item in this report is a drain tube adapter.
Drain tube adapters are correctly billed to Medicare using HCPCS code:
A4331 - EXTENSION DRAINAGE TUBING, ANY TYPE, ANY LENGTH, WITH CONNECTOR/ADAPTOR, FOR USE WITH URINARY LEG BAG OR UROSTOMY POUCH, EACH
Correct coding is an essential element for correct claim payment. The Pricing, Data Analysis, and Coding (PDAC) contractor maintains a variety of resources to assist suppliers in determining the appropriate code for Medicare billing. For questions about correct coding, contact the PDAC Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail questions to the PDAC by completing the DME PDAC Contact Form.
Published by Noridian as the PDAC, November 2017. Republished by Palmetto GBA as the PDAC, January 2019.