Urology Billing Codes and Guidelines
Urology Billing Guidelines
The Medicare urology guidelines require you to submit a Standard Written Order (SWO) for your patient before they can receive urological items. The SWO must include the following to comply with urological guidelines for billing insurance:
- Patient’s name
- Medicare Beneficiary Identifier
- Order date
- Description of urological item
- Quantity to dispense
- Frequency of use per day
- Treating practitioner name and NPI
- Treating practitioners signature (must be handwritten or electronically signed through a qualified E-Prescribing system)
A new SWO is needed any time you need to add an item to your patient’s order or change their treatment. We advise you to document your patient’s continued needs yearly.
Urology Medical Records Requirements
Your patient’s insurance may also require detailed information from their medical record to confirm that the supplies ordered on their behalf are medically necessary. The individual patient’s medical record must verify:
- The patient has permanent urinary incontinence or permanent urinary retention that will not be medically or surgically corrected within 3 months.
- For coudé or curved-tip catheters, you must provide either:
- Documentation that the patient has tried and failed to use a straight-tip catheter, or
- Additional details to indicate why the patient is unable to use a straight-tip catheter.
- For sterile intermittent catheter kits (or Closed System Catheter Kits) you must provide additional details to prove the patient meets one of these specific criteria:
- Patient resides in nursing facility
- Patient is immunosuppressed (post-transplant drug regimen, chemotherapy, AIDS, etc.)
- Patient has radiologically documented vesicoureteral reflux while on IC Program
- Patient is a pregnant female with a spinal cord injury (only for duration of pregnancy)
- Patient has recurring UTIs while using A4351/A4352 with lubricant (patient must have two distinct UTIs within 12 months before using A4353. Laboratory findings are also required)
Our team will verify that all the information needed in the SWO and medical record complies with urology billing guidelines so that Medicare will give your patient the coverage they need with as little back and forth as possible.