How To Use HCPCS Code A5081

HCPCS code A5081 describes a stoma plug or seal, which can be of any type. This code is used to identify and bill for the supply of stoma plugs or seals that are used to close or seal an opening in the body, such as a stoma, which is a surgically created opening on the abdomen to divert waste from the digestive or urinary system. Stoma plugs or seals are designed to prevent leakage and provide a secure closure for the stoma.

1. What is HCPCS A5081?

HCPCS code A5081 is used to identify and bill for stoma plugs or seals, regardless of the type. These plugs or seals are used to close or seal an opening in the body, such as a stoma. Stoma plugs or seals are typically made of medical-grade materials and are designed to provide a secure closure and prevent leakage.

2. Official Description

The official description of HCPCS code A5081 is “Stoma plug or seal, any type.” The short description is “Stoma plug or seal, any type.” This description accurately represents the purpose and use of this code.

3. Procedure

1. Ensure the stoma plug or seal is appropriate for the patient’s specific needs and stoma type.
2. Clean the stoma and surrounding area with mild soap and water, ensuring it is dry before applying the plug or seal.
3. Remove the protective backing from the adhesive side of the plug or seal.
4. Position the plug or seal over the stoma, ensuring a secure and snug fit.
5. Gently press the plug or seal onto the skin surrounding the stoma to ensure proper adhesion.
6. Ensure the plug or seal is comfortable for the patient and does not cause any irritation or discomfort.

4. When to use HCPCS code A5081

HCPCS code A5081 should be used when supplying stoma plugs or seals to patients who require them to close or seal their stomas. This code is applicable for any type of stoma plug or seal, regardless of the specific design or material. It is important to ensure that the stoma plug or seal is appropriate for the patient’s specific needs and stoma type.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A5081, healthcare providers should ensure that the following documentation is included:

• Medical records indicating the need for a stoma plug or seal
• Prescription or order for the stoma plug or seal
• Itemized invoice or receipt for the supply

Providers should follow the appropriate billing guidelines and submit the claim with the necessary supporting documentation to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code A5081 was added to the Healthcare Common Procedure Coding System on January 01, 1990. It has an effective date of January 01, 2014. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code A5081 is covered by Medicare and other insurance providers. The pricing indicator code for this code is 37, which indicates that it falls under the category of ostomy, tracheostomy, and urological supplies. The pricing for this code is subject to floors and ceilings, ensuring that the reimbursement is within a reasonable range.

8. Examples

Here are five examples of when HCPCS code A5081 should be billed:

1. A patient with a colostomy requires a stoma plug to securely close the stoma and prevent leakage.
2. A patient with a urostomy needs a stoma seal to provide a secure closure and prevent urine leakage.
3. A patient with a tracheostomy requires a stoma plug to close the tracheostomy tube when not in use.
4. A patient with an ileostomy needs a stoma seal to ensure a secure closure and prevent stool leakage.
5. A patient with a continent urinary diversion requires a stoma plug to close the stoma and maintain continence.