Correct Coding - Hygienic Cleansers Diapers and Underpads - JA DME

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.

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