CORRECT CODING – HYGIENIC CLEANSERS, DIAPERS, AND UNDER-PADS


DME MAC Joint Publication

A recent analysis of HCPCS code A4335 (INCONTINENCE SUPPLY; MISCELLANEOUS) revealed that 93% 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 items in this report are hygienic cleansers, diapers, and under-pads.

Hygienic cleansers include a variety of products but most common are cleansing “wipes”. The correct HCPCS code for billing any hygienic cleansing item is:

A9286 - HYGIENIC ITEM OR DEVICE, DISPOSABLE OR NON-DISPOSABLE, ANY TYPE, EACH

All under-pads are correctly billed to Medicare using one of the following HCPCS codes:

A4553 - NON-DISPOSABLE UNDER-PADS, ALL SIZES
A4554 - DISPOSABLE UNDER-PADS, ALL SIZES

Diapers and any other type of incontinence garment are billed using HCPCS code:

A4520 - INCONTINENCE GARMENT, ANY TYPE, (E.G., BRIEF, DIAPER), 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.



Last Updated: 11/29/2017