Reader Questions: Payment for Supplies

Question: How can we get paid for supplies for a new patient seen for infected sebaceous cyst (706.2) in an inpatient setting? The patient was referred by her primary care physician, and incision and drainage (I & D) had to be done the same day. Should I use 99243 (consultation) or 99204 (new patient exam) for I & D (10061). How can we get paid for supplies used for the I & D, such as the xylocaine, needles, blades, and bandages used for the procedure? What is the best code to use? Should we use any modifiers? For a new patient seen for a sebaceous cyst (706.2) we used 99243-57 for the consultation and 11402 for the excision. Again, how would we receive compensation for supplies? Should we use 99010 alone or with a modifier?

Michigan Subscriber

Answer: Medicare does not pay for supplies, so dont expect to be paid. If the supply costs are too high, the patient can be brought to the operating room (OR) to have the debridement of the infected sebaceous cyst. Other payers may pay for the supplies; you should check the provider contracts and ask the provider representatives. Some payers include a facility fee with the CPT payment and feel they are paying sufficiently for the supplies (their reimbursement for office procedures is higher because of the costs to the doctor than the reimbursement for the OR).

You can try to bill for a surgical tray, A4550. Medicare will not pay for the surgical tray for this procedure.

There are limited procedures for which Medicare pays A4550, and they are outlined in Medicare Carriers Manual 15030. As far as consultations versus new patient visits, the chart has to indicate if the patient was sent for the debridement and the surgeon did it, or if the patient was sent for the surgeons opinion and the surgeon determined he/she should debride or excise.

If the second is documented and a letter goes to the requesting physician, it is a consult. If the first is documented, it is a new patient. See Section 15506 of the Medicare Carriers Manual for the rules on consultation versus transfer of care.

- Published on 2000-07-01