The short answer is…No.
Medicare will not make separate payments for items dispensed during any inpatient stay in acute care hospitals, long-term care hospitals, inpatient rehabilitation facilities, or critical access hospitals. Medicare makes payments to these entities via different payment systems and all payments made through these systems are considered to be payment in full, including any DME items dispensed during the stay.
What If You Try?
Medicare is clear in its communication regarding what to expect if supplies are dispensed during an inpatient stay. Medicare relates that it will not pay the supplier for items that were dispensed. Furthermore, if any deductible or coinsurance was inappropriately collected from an inpatient, it must be refunded to the patient.
Why Can’t You Dispense Dressings to an Inpatient?
The Social Security Act states that DME coverage is only available for items that will be used in the patient’s home. The inpatient settings listed above, as well as Skilled Nursing Facilities (SNFs) are not considered the patient’s home. The institution where the inpatient stay takes place is supposed to provide all medically necessary DME items during the stay, and payment for those items is included in the institution’s payment for the stay.
Are There Any Exceptions?
When certain criteria are met, a supplier may dispense certain DME items to an inpatient prior to discharge. However, there is a long list of criteria that must be met and this exception applies ONLY to prosthetics and orthotics and does not apply to dressings/supplies.
DISCLAIMER: The information provided here is intended to educate health care providers regarding compliance for ICD, CPT, and HCPCS coding. The information provided does not guarantee reimbursement and is accurate to the best of our knowledge at the time of this publication. Coding guidelines can change and we encourage you to stay up to date. The existence of a code does not guarantee payment.
Dr. Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC, CPMA
Dr. Lehrman is a podiatrist practicing in Fort Collins, CO and operates Lehrman Consulting, LLC which provides consultation services regarding coding, compliance and documentation. Dr. Lehrman is a Certified Professional Coder and Certified Professional Medical Auditor. He serves as a staff liaison at the AMA CPT® Editorial Panel meetings where CPT codes are created, edited, and deleted. He is a Diplomate of the American Board of Foot and Ankle Surgery, Fellow of the American Society of Podiatric Surgeons, and is recognized as a “Master” by the American Professional Wound Care Association. Dr Lehrman is a Fellow of the American Academy of Podiatric Practice Management, Past Director of the American Professional Wound Care Association Board of Directors, and is a Past Chairman of the Board of the American Society of Podiatric Surgeons. Dr. Lehrman is also on the editorial advisory board of the journal WOUNDS.
