[Margie]

Has anyone had a patient that uses both BOLUS and PUMP feedings?
Can you get reimbursement for BOTH sets of supplies? (B4034 & B4035)?

THANKS

[DeeDee]

Margie,

I have never come across this. The following is cut from the Region B coverage determination:

The feeding supply kit (B4034-B4036) must correspond to the method of administration indicated in question 5 of the DME Information Form (DIF). If it does not correspond, payment for the billed code will be based on the allowance for the code relating to the method of administration specified on the DIF or the billed code, whichever is less. If a pump supply kit (B4035) is ordered and the medical necessity of the pump is not documented, payment will be based on the allowance for the least costly medically appropriate alternative, B4036.


The codes for feeding supply kits (B4034-B4036) are specific to the route of administration. Claims for more than one type of kit code delivered on the same date or provided on an ongoing basis will be denied as not medically necessary.

The link for that LCD is: http://www.ngsmedicare.com/content.a...ontentID=19509

I would think that you would definitely have to take the claims to appeals and have a substantial amount of documentation from the physician as to why both methods of administration are required.

~Dee Dee

[Margie]

Ok Thanks for the help..

We do have a pt that is bolus during day and continuous on pump at night

[SimplyLori]

If your pump patients use a 60cc syringe for flushing you really wouldn't need anything extra supplies for when they bolus feed.... It would be nice to get paid extra but for our company anyway, it wouldn't cost us a penny more!

[CrystalO]

Being able to tolerate bolus feedings during the day might negate the medical necessity of a feeding pump. Feeding pumps are medically necessary when the patient cannot tolerate a bolus feeding.

[SimplyLori]

I agree that if the patient can tolerate bolus a pump wouldn't be necessary however, we've had the same situation as above with Medicare. The patient can't get enough calories with Bolus or gravity by day so they add more all night via pump. So far no problems but then I don't think we were ever audited on that so you can never be totally sure these days!