Urology Coding Alert
In-Office Cunningham Clamp = A4356
Question: My doctor is giving a patient a Cunningham clamp in the office for incontinence. Can I bill the insurance for this? If so, how do I code it? If not, can I bill the patient a self pay price for this or do I send them to a DME company or pharmacy to get reimbursement?
Florida Subscriber
Answer: If the clamp is being used for a temporary problem given to the patient from the office, bill the charge to the patient’s insurance company using HCPCS code A4356 (External urethral clamp or compression device [not to be used for catheter clamp], each). Some payers may reimburse you, but others may not.
If the clamp is for a permanent patient problem, then bill the Durable Medical Equipment Regional Office (DMERO) using A4356.
Tip: Most physicians are asking the patient to obtain/buy the clamp from a surgical supply house where they may be able to be reimbursed from the DMERO.
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