FUTURE ARTICLE : DRAFT Suction Pumps - Policy - XXXXXXX (A51297) d Page 1 of 5 DRAFT Suction Pumps - Policy - XXXXXXX CIGNA Government Services Jump to Section... Please note: This is a Future. Contractor Information Contractor CIGNA Government Services Name Contractor 18003 Number Contractor DME MAC Type Other Contractor Numbers to which this article applies Information Database ID Number Type back to Key A51297 Yes Version 4 Number Title DRAFT Suction Pumps - Policy - XXXXXXX AMA CPT / ADA CPT codes, descriptions and other data only are copyright 2010 American Medical
Page 2 of 5 CDT Copyright Statement Primary Geographic Jurisdiction back to DME Region Covers Original Ending Revision Revision Ending back to Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. AL AR CO FL GA LA MS NC NM OK PR SC TN TX VA VI WV Jurisdiction C 11/11/2011 Text NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare statutory and regulatory requirements. Information provided in this policy article relates to determinations other than those based on Social Security Act 1862 (a)(1)(a) provisions (i.e. reasonable and necessary ). Suction equipment is covered under the Durable Medical Equipment benefit (Social Security Act 1861(s)(6)). In order for a beneficiary s equipment to be eligible for reimbursement the reasonable and necessary (R&N) requirements set out in the related Local Coverage Determination must be met. In addition, there are specific statutory payment policy requirements, discussed below, that also must be met. Saline used for tracheal lavage is a noncovered supply. Tracheal suction catheters (A4605, A4624) and sterile water, saline used for suctioning (A4216, A4217) are considered supplies for durable medical equipment. Therefore, when supplied to beneficiaries in nursing facilities, Place of Service 31 and 32, they will be
Page 3 of 5 denied as noncovered. Supplies other than suction catheters and saline are not considered supplies for DME and are therefore noncovered. Disposable wound suction pumps and related supplies will be denied as statutorily noncovered because they do not meet the DME benefit. CODING GUIDELINES: A portable or stationary home model respiratory suction pump (E0600) is an electric aspirator designed for oropharyngeal and tracheal suction. A portable or stationary home model gastric suction pump (E2000) is an electric aspirator designed to remove gastrointestinal secretions. A closed system tracheal suction catheter (A4605) is a type of suction catheter that is protected by an outer sheath. It is connected to the ventilator circuit of a patient on mechanical ventilation and left in place. Suctioning is accomplished without disconnection from ventilation. A tracheal suction catheter (A4624) is a long, flexible catheter. An oropharyngeal catheter (A4628) is a short, rigid (usually) plastic catheter of durable construction. Wound suction is provided with an integrated system of components. This system contains a pump (K0743) and dressing sets (K0744 K0746). It does not include a separate collection canister (A7000), a defining component of Negative Pressure Wound Therapy (NPWT). Instead, exudate is retained in the dressing materials. Wound suction systems that do not contain all of the required components are not classified as wound suction systems. See below for component specifications Code K0743 describes a suction pump for wounds which provides controlled subatmospheric pressure that is designed for use with dressings, (K0744 K0746) without a canister. K0744- K0746 describe an allowance for dressing sets which are used in conjunction with a stationary or portable suction pump (K0743) but not used with a canister. Each of these codes (K0744 K0746) is used for a single, complete dressing change, and contains all necessary components, including but not limited to non-adherent porous dressing, drainage tubing, and an occlusive dressing which creates a seal around the wound site for maintaining subatmospheric pressure at the wound. These dressing sets are selected based upon wound size using the smallest size necessary to cover the wound. For multiple wounds located close together, a single large dressing must be used rather than multiple smaller dressing sets if it is possible to fit the wounds under a single larger dressing set. Disposable wound suction system pumps must be coded A9270 (Noncovered item or service). Supplies used with disposable wound suction systems must be coded as A9270 (Noncovered item or service) The only products which may be billed using codes K0743 are those for which a written Coding Verification Review has been made by the Pricing, Data Analysis and Coding (PDAC) Contractor and subsequently published on the appropriate Product Classification List. Suppliers should contact the PDAC Contractor for guidance on the correct coding of these items. Coding Information
Page 4 of 5 Bill Type Revenue CPT/HCPCS Does the CPT 30% Coding Rule Apply? back to No ICD-9 that are Covered ICD-9 that are Not Covered Other Information Other Comments Approval Notes Revision History Explanation back to Related Local Coverage Documents Related National Coverage Documents Attachments back to Saved By Revision : XX/XX/XXXX NONMEDICAL NECESSITY COVERAGE AND PAYMENT RULES: ADDED: Preamble Added: Benefit Category Statement CODING GUIDELINES: Added: K0743 K0746 Added: PDAC review requirement for K0743 LCD(s) DL5027 - Suction Pumps - DRAFT Please Note: Until further notice, this field will only display on the LCBE Database. Users will be informed when the related NCDs will display on the CMS MCD. There are no attachments for this Wilma Johnson Saved On 07/29/2011 13:21:30
Page 5 of 5 Approved? All Versions back to Yes Version 4 - Updated on 07/29/2011 13:21:30, by Wilma Johnson, with effective dates 11/11/2011 - N/A (Approved). Version 3 - Updated on 07/26/2011 14:54:23, by Wilma Johnson, with effective dates Version 2 - Updated on 07/26/2011 12:19:01, by Wilma Johnson, with effective dates Version 1 - Updated on 07/25/2011 16:19:48, by Wilma Johnson, with effective dates Close This website is an official service of the Centers for Medicare & Medicaid Services.