How To Use HCPCS Code A5105

HCPCS code A5105 describes a urinary suspensory with a leg bag, with or without a tube. This code is used to identify the specific medical supply that is used to support and secure a urinary catheter and collect urine in a leg bag. It is important for medical coders to understand the details and usage of this code to ensure accurate billing and reimbursement.

1. What is HCPCS A5105?

HCPCS code A5105 is used to identify a urinary suspensory with a leg bag, which is a medical device used to support and secure a urinary catheter and collect urine. The code represents a specific product that is used in urological care for patients who require urinary catheterization. It is important to note that this code can be used with or without a tube, depending on the specific product being used.

2. Official Description

The official description of HCPCS code A5105 is “Urinary suspensory with leg bag, with or without tube, each.” This description accurately represents the product being coded and provides important details about the specific components included in the urinary suspensory. The short description for this code is “Urinary suspensory,” which provides a concise summary of the product.

3. Procedure

1. When using HCPCS code A5105, the healthcare provider will first assess the patient’s need for a urinary catheter and determine the appropriate size and type.
2. The provider will then select a urinary suspensory with a leg bag that meets the patient’s needs and preferences.
3. The urinary suspensory will be applied to the patient’s leg, ensuring a secure and comfortable fit.
4. If a tube is required, it will be connected to the urinary catheter and secured in place.
5. The leg bag will be attached to the urinary suspensory, allowing for the collection of urine.
6. The healthcare provider will educate the patient on proper usage and care of the urinary suspensory and leg bag.

4. When to use HCPCS code A5105

HCPCS code A5105 should be used when a healthcare provider supplies a urinary suspensory with a leg bag to a patient who requires urinary catheterization. This code is applicable for patients who need a secure and convenient method for collecting urine. It is important to ensure that the specific product being provided matches the description and components outlined in the code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A5105, healthcare providers should ensure that the following documentation is included:

• Medical records indicating the patient’s need for a urinary catheter and the specific product provided
• A detailed description of the urinary suspensory and leg bag, including any additional components such as a tube
• Date of service and duration of use, if applicable
• Any relevant supporting documentation, such as a prescription or order from a healthcare provider

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

6. Historical Information and Code Maintenance

HCPCS code A5105 was added to the Healthcare Common Procedure Coding System on January 01, 1990. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code has an effective date of January 01, 2008, which signifies when it became active for use in medical coding and billing.

7. Medicare and Insurance Coverage

HCPCS code A5105 is classified under the pricing indicator code 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, meaning that there may be limitations on the reimbursement amount. The multiple pricing indicator code A indicates that this code is not applicable as HCPCS priced under one methodology.

Medicare and other insurance providers may cover the cost of urinary suspensories with leg bags when they are medically necessary. However, coverage may vary depending on the specific insurance plan and the patient’s eligibility criteria. It is important for healthcare providers to verify coverage and follow the appropriate billing guidelines to ensure reimbursement.

8. Examples

Here are five examples of when HCPCS code A5105 should be billed:

1. A patient with urinary incontinence requires a urinary catheter and is provided with a urinary suspensory with a leg bag for convenient urine collection.
2. A patient with a spinal cord injury needs a urinary catheter and is supplied with a urinary suspensory with a leg bag to manage their urinary function.
3. A patient undergoing post-operative care following urological surgery requires a urinary catheter and is given a urinary suspensory with a leg bag for urine drainage.
4. A patient with a chronic illness that affects their bladder function needs a urinary catheter and is provided with a urinary suspensory with a leg bag to maintain their urinary hygiene.
5. A patient with limited mobility who is unable to access a bathroom independently requires a urinary catheter and is given a urinary suspensory with a leg bag to facilitate urine collection.