[whozleft]

Hi all,

Can anyone weigh in on what you include in your "kits when billing Medicaid. Specifically code number B4035.

B4035

Enteral Feedg Supp Kit;Pump(Mnthly(Incl

01/01/2010

2

6.79

7.00

I cannot find a definitive answer anywhere. I am asking because I am being asked to include more and more items and just include it in the "kit charge" instead of billing items individually. The organization i work with has been mopre than generous in supplying items in the kit and I feel my dept. is losing some revenue when it doesn't need to do so.

Thanks for sharing any thoughts on this.

[Regina]

After much searching, I found this on the Noridian website-

When billing for these codes, suppliers are reminded that the fees for these codes are all-inclusive. It is inappropriate to unbundle and bill separately for these items. The "Coding Guidelines" section of the Enteral Nutrition - Policy Article states:

"The codes for enteral feeding supplies (B4034-B4036) include all supplies, other than the feeding tube itself, required for the administration of enteral nutrients to the patient for one day. Codes B4034-B4036 describe a daily supply fee rather than a specifically defined "kit." Some items are changed daily; others may be used for multiple days. Items included in these codes are not limited to pre-packaged "kits" bundled by manufacturers or distributors. These supplies include, but are not limited to, feeding bag/container, flushing solution bag/container, administration set tubing, extension tubing, feeding/flushing syringes, gastrostomy tube holder, dressings (any type) used for gastrostomy tube site, tape (to secure tube or dressings), Y connector, adapter, gastric pressure relief valve, declogging device, etc. These items must not be separately billed using the miscellaneous code (B9998) or using specific codes for dressings or tape. The use of individual items may differ from patient to patient and from day to day. Only one unit of service may be billed for any one day. Units of service in excess of one per day will be rejected as incorrect coding." (Emphasis added.)

[Sleeping410]

Good answer Regina. We also are asked (especially by Medicaid) to include several items in this "kit". It really get expensive with the low profile (button type) feeding tube and extension sets.

[Regina]

I notice that is says "include, but are not limited to". Leaves a whole lot of room for interpretation. So what exactly CAN be billed with B9998? Why does it have to be so confusing?

[Sleeping410]

The kit must include "anything" necessary to provide the enteral nutrition to the patient. BCBS has informed us that nothing that is used for the provision of the enteral nutrient should be billed seperately from this kit.

[whozleft]

I understand what is included in the "kit", I think my question came in because 95% of what we do is the low profile MicKey buttons. Some people are asking for 8 extension tubes/month while others use only 2 per/month.

My question is if anyone has determined what their standard kit includes. What amount of extension sets would you all think appropriate? The manufacturer says the tubes can be flushed and also wiped clean on the outside. They also state that the tubes are good to use until they can no longer be cleaned properly, develop cracks, or they stop working all together. The tubes cost over $7.00 each and to send out an exhorbant amount each month can make a huge impact.

I do realize there are exceptions that have to be taken care of, and we certainly want to keep patient care at the top of the list. I just think we need to do this and also watch the bottom line.

Thanks

[SimplyLori]

I agree the extention sets are killers but fortunately we don't have a lot. We mostly do 1 600cc syringe, 1 split 4x4 with the bag and/or spike set. G-tube holders we try to limit to one every 3 months with a new g-tube. When someone needs or wants more we ask for justification from the doctor to show what the policy calls for "medically necessary supplies". One problem is that some facilities have licensing guidelines to follow. We don't include quantities needed for them to comply. Only what is necessary to the patient.