Noridian has received notification of errors from CERT for the following type of claims:

Coude tip catheter (A4352)

CERT has identified the main causes of these errors due to:

• Order is written for a straight catheter instead of the billed Coude catheter.
• Clinical record missing documentation of beneficiary’s inability to pass a straight tip catheter.

To be compliant with Local Coverage Determination (LCD) for Urological Supplies:

Documentation would include:

• Referring practitioner’s orders or associated practitioner’s orders for the billed intermittent Coude catheter (A4352).
• Documentation in the beneficiary's medical record of the medical necessity for that catheter. An example would be the inability to catheterize with a straight tip catheter.

This documentation must be available upon request. If documentation is requested and does not substantiate medical necessity, claims will be denied as not reasonable and necessary.

Resources:

• Urological Supplies Local Coverage Determination (LCD)
• Urological Supplies Policy Article
• Standard Documentation Requirements for All Claims Submitted to DME MACs