RETIRED - Correct Coding - Urinary No-Touch Catheters - JD DME

Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.

DME MAC Joint Publication

Urinary "no-touch" catheter systems are designed to perform urinary catheterization without the need to directly touch the catheter during insertion. The Urologic Supplies Local Coverage Determination (LCD) provides coverage for these products as either a single-use intermittent catheter (A4351, A4352) or as a sterile kit (A4353) depending upon the configuration of the specific product. The narratives for these HCPCS codes are:

A4351 - INTERMITTENT URINARY CATHETER; STRAIGHT TIP, WITH OR WITHOUT COATING (TEFLON, SILICONE, SILICONE ELASTOMER, OR HYDROPHILIC, ETC.), EACH

A4352 - INTERMITTENT URINARY CATHETER; COUDE (CURVED) TIP, WITH OR WITHOUT COATING (TEFLON, SILICONE, SILICONE ELASTOMERIC, OR HYDROPHILIC, ETC.), EACH

A4353 - INTERMITTENT URINARY CATHETER, WITH INSERTION SUPPLIES

In order to be correctly coded as A4353 the no-touch catheter must meet all of the requirements specified in the CODING GUIDELINES section of the Urologic Supplies related Policy Article. The guideline for A4353 says:

An intermittent urinary catheter with insertion supplies (A4353) is a kit, which includes a catheter and all supplies necessary for a single, sterile insertion (see below). Code A4353 may be used if any of the following 1, 2, or 3 is supplied:

1. A single sterile package containing both an intermittent urinary catheter and all necessary insertion/collection supplies: or
2. A sterile intermittent urinary catheter plus a separately-packaged sterile kit containing all necessary insertion/collection supplies; or,
3. A sterile "no-touch" type of catheter system.

The insertion kit (A4353) described in #1 and #2 above contains an intermittent urinary catheter (packaged separately from the other components in #2), lubricant, gloves, antiseptic solution, applicators, a drape, and a collection tray/bag in a sterile package intended for single use. The collection tray/bag is a separate item included within the kit; therefore, materials that serve as non-sterile packaging to contain all of the items in the kit do not meet this requirement.  Except as noted in #2 above, code A4353 must not be billed if individual insertion kit components are provided as separate items. When providing a sterile kit, all components are included and packaged as a kit. Separate billing of individual components is considered as unbundling.

The product described in #3 is a single-catheter system that is functionally equivalent to a complete sterile insertion kit (A4353) containing a catheter and the additional components as described in the previous paragraph. In order to be coded as A4353, a "no-touch" type of catheter system must be a sterile, all-inclusive, self-contained system capable of accomplishing intermittent catheterization with sterile technique without the use of additional supplies such as gloves, lubricant, collection chamber, etc. Additional individual components must not be separately billed. Separate billing of additional supply items is considered as unbundling. (Emphasis added)

Only those "no-touch" systems that are the complete functional equivalent of a standard sterile kit, including the presence of a collection chamber, are eligible to be coded as A4353. The collection chamber may be an integral part of the catheter or may be a separate item provided as part of the complete system. Systems that do not have a collection chamber or otherwise are not functionally equivalent in performing a sterile-technique catheter insertion must be coded as an intermittent catheter, A4351 or A4352, depending upon the catheter configuration.

Refer to the Urologic Supplies LCD and related Policy Article for additional information about coverage, documentation and coding.

For questions about correct coding, contact the Pricing, Data Analysis and Coding (PDAC) contractor Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form.