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Marysville, WA

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Scottsdale, AZ

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Ladera Ranch, CA

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Medicare Patient Documentation Urinary Tract Infections (urine cultures)

Medicare will provide its members with one-time, sterile use catheterization for up to200 straight catheters per month with individual lubricant packets. To receive advancedproducts such as closed systems and hydrophillic catheters, additional documentation isrequired. To service these members, the following three items are required:

1. PLAN OF CARE (PRESCRIPTION)

On the plan of care, check the “yes” box on “Does the patient have permanent urinary incontinence?”; according to Medicare, “yes” means that the patient will have this condition for more than 3 months.

2. TWO URINE CULTURE LAB REPORTS WITHIN TWELVE (12) MONTHS OF EACH OTHER

Both lab reports must have a urine culture greater than 10,000 cfu (colony forming units). The two urine cultures lab reports can be as far back as 30 years ago or more.

3. ONLY ONE (1) CONCURRENT SYMPTOM PER URINE CULTURE LAB REPORT

This can be obtained from:U/A (urinalysis) – look for

  1. wbc (white blood cell) count greater than five (5).

Doctor’s progress notes – look for one of the following:

  1. fever (>100.4);
  2. systemic leukocytosis;
  3. change in urgency, frequency or incontinence;
  4. autonomic dysreflexia;
  5. prostatitis;
  6. epididymitis;
  7. orchitis;
  8. increased muscle spasms.

Special Notations:

  • Please make sure that the dates of the U/As and doctor’s progress notes are around the same time as each urine culture lab report.
  • Patients with private insurance – only need a prescription.


Example of a Urine Culture Lab Report

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Example of a Concurrent Symptom

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