How To Use HCPCS Code E0186

HCPCS code E0186 describes an air pressure mattress used for medical purposes. This code is used to identify the specific type of mattress that provides therapeutic support and pressure redistribution for patients who are bedridden or have limited mobility. In this article, we will explore the details of HCPCS code E0186, including its official description, procedure, usage guidelines, billing requirements, historical information, and coverage by Medicare and other insurance providers.

1. What is HCPCS E0186?

HCPCS code E0186 is used to identify an air pressure mattress that is designed to prevent or treat pressure ulcers in patients who are at risk. This mattress utilizes air cells that can be adjusted to provide varying levels of pressure redistribution, promoting better circulation and reducing the risk of skin breakdown. It is typically used for patients who are bedridden or have limited mobility, such as those in long-term care facilities or home healthcare settings.

2. Official Description

The official description of HCPCS code E0186 is “Air pressure mattress.” The short description is “Enteral supp not otherwise c.” This description accurately reflects the purpose and nature of the product.

3. Procedure

1. Prepare the air pressure mattress by ensuring it is clean and in proper working condition.
2. Position the patient on the mattress, ensuring proper alignment and comfort.
3. Adjust the air pressure settings according to the patient’s needs and the healthcare provider’s instructions.
4. Monitor the patient’s response to the mattress and make any necessary adjustments to ensure optimal pressure redistribution.
5. Regularly inspect and maintain the mattress to ensure its continued effectiveness and safety.

4. When to use HCPCS code E0186

HCPCS code E0186 should be used when providing an air pressure mattress to patients who require pressure redistribution to prevent or treat pressure ulcers. This code is applicable for patients who are bedridden or have limited mobility and are at risk of developing pressure ulcers. It is important to ensure that the patient meets the specific eligibility criteria for using this code, as determined by the healthcare provider and insurance guidelines.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code E0186, healthcare providers need to document the medical necessity of the air pressure mattress and provide supporting documentation, such as the patient’s medical records, physician orders, and any relevant clinical notes. It is important to accurately code and describe the service or supply provided, ensuring that all required information is included in the claim submission. Additionally, providers should follow the billing guidelines and requirements set forth by Medicare and other insurance payers to ensure proper reimbursement.

6. Historical Information and Code Maintenance

HCPCS code E0186 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. 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 remained unchanged since its addition to the HCPCS.

7. Medicare and Insurance Coverage

HCPCS code E0186 is covered by Medicare and other insurance providers. The pricing indicator code for this code is 57, which indicates that it is priced by other carriers. The multiple pricing indicator code is A, which means it is not applicable as HCPCS priced under one methodology. Medicare and other insurance providers determine the reimbursement rates for this code based on their respective fee schedules and coverage policies.

8. Examples

Here are five examples of when HCPCS code E0186 should be billed:

1. A patient with limited mobility and a high risk of developing pressure ulcers requires an air pressure mattress for pressure redistribution and prevention.
2. A long-term care facility provides an air pressure mattress to a bedridden patient to promote better circulation and reduce the risk of pressure ulcers.
3. A home healthcare agency supplies an air pressure mattress to a patient who is recovering from surgery and is confined to bed rest.
4. A hospice organization provides an air pressure mattress to a terminally ill patient to ensure comfort and prevent skin breakdown during the end-of-life care.
5. A durable medical equipment supplier delivers an air pressure mattress to a patient’s home as prescribed by their healthcare provider to aid in the healing of existing pressure ulcers.