Cath Lab Digest

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Coverage Savvy
  For the past 3 years, the Centers for Medicare and Medicaid Services (CMS) covered the monthly cost of up to 200 single-use, disposable catheters for any Medicare beneficiary who met the basic coverage criteria. This coverage includes Medicare beneficiaries with permanent urinary incontinence or urinary retention. Each can receive one sterile urological catheter and one packet of lubricant for each episode of covered catheterization for emptying one’s bladder. This represented a long-awaited deviation from past coverage policy that stipulated a fixed number of catheters (four) were allowed monthly, for which the cost would be covered regardless of the patient’s medical circumstances.

  Today, as a result of this substantial change in policy, intermittent catheterization (IC) using a sterile intermittent catheter is covered when the Medicare beneficiary meets one of the following criteria:

    • Resides in a nursing facility;

    • Is immune-suppressed, such as a person diagnosed with AIDS or on chemotherapy for treatment of cancer;

    • Is pregnant with a spinal cord injury (SCI);

    • Has documented vesico-ureteral reflux, a concern and possible complication particularly for people living with SCI; or

    • Has experienced two or more documented urinary tract infections (UTIs) a year.

  Many Medicare beneficiaries qualifying for such coverage, as well as their providers, remain unaware of the progressive change in policy, and as such are vulnerable to recurrent and costly UTIs. For persons qualifying for sterile, disposable catheters, cleaning and reusing catheters is no longer necessary.

  The NAFC diligently continues to communicate this change in coverage policy. The Association also continues to seek policy updates by private payors, encouraging them to follow Medicare guidelines on this matter for their enrollees. OWM readers are urged to contact the NAFC to act as an ally in your local battle. In the meantime, patients whose health status remains compromised, such as those with a SCI, remain at risk of infections and complications and should be educated regarding how to be vigilant regarding their condition.

Bladder Infections
  Most UTIs are caused by bacteria that normally live in the colon and rectum and are present in bowel movements. The bacteria cling to the opening of the urethra, begin to multiply, and travel up to the bladder. UTIs that occur only in the bladder are called cystitis. If the infection is in the urethra, it is called urethritis. If it gets into the kidneys, it is called pyelonephritis. Because women have a shorter urethra, they are much more prone to develop UTIs than men. Plus, after menopause and especially with weakened sphincter tone, older women are likely to have residual urine retained at the bladder neck and trapped in the urethra, creating a haven for bacteria and increasing the potential for UTIs. Younger women with multiple sexual partners are also more likely to experience recurrent UTIs.

  People with a SCI also are more susceptible to UTIs because the bladder does not function as efficiently as it should. However, when a UTI is suspected, practitioners try to avoid administering antibiotics excessively or without due cause.