Questions from a new Indiana Poucher

Tammy for the surgeon who won't write you a script...hand him this and demand it.......lunkhead!
Subject: Intermittent Urinary Catheterization

Dear Physician,

Recently Medicare changed the local coverage determination (LCD) for urological supplies. The previous policy covered “clean technique” for patients without a history of recurring urinary tract infections - allowing four intermittent catheters per month, which were cleaned and re-used. Now any patient who utilizes intermittent catheterization can receive one sterile urological catheter and one packet of lubricant for each catheterization.

Because of this change in Medicare policy, medical equipment suppliers may be contacting you for new prescriptions for your patients. There are a couple of important points to keep in mind. First, the prescription should reflect the actual number of times that the patient actually catheterizes him/herself per day. For example, if the patient self-catheterizes four times per day, the prescription should be for approximately 120 catheters per month. Although the LCD says that Medicare will cover up to 200 intermittent catheters per month, this is a maximum number and most patients self-catheterize less than 6 times per day. It would be inappropriate to order 200 catheters per month for every patient. The prescription must be individualized for each patient.

The second important point is that you should clearly document in your chart the number of times per day that the patient performs self-catheterization. Just listing that value on the prescription or on a separate form provided by the supplier is not sufficient. In the case of an audit, we would look for documentation in the patient’s medical record.

Thank you for your cooperation and your care of Medicare beneficiaries.


Paul J. Hughes, MD Adrian M. Oleck, MD
Medical Director Medical Director
DME MAC Jurisdiction A DME MAC Jurisdiction B

furthermore refer him to this article in urotoday....just register and its free to access.
www.urotoday.com/index.php?option=com_content&task=view_ua&id=2220341

If hes still being a lunkhead about it go to the Head of Urology...go to a patients advocate.......Dr. Gill my surgeon at Cleveland absolutely believed that you should never reuse a catheter. Fight for your rights....

Pat
P.S. I know this is a Medicare ruling but what Medicare does all insurance companies should follow suit regardless of age.

Stool?
Pat

And another thing that is handy to keep around, either in purse or pocket, is what I call a "barf bag" that they hand you in the hospital. Next time you're there, ask for a couple. They're blue plastic, and they are graduated, so you can measure, and then dump in the stool, and toss in the garbage. They fold flat for storage, and are lightweight. I used to keep them in every bathroom and the cars, just in case we needed to measure.

Stephany in Iowa

Bill,

Bless your heart for mentioning my website ...Pat did also, earlier on this thread. If my home PC is working right this weekend, it's (ugh) dial up, I plan to do some editing and addition to that site. Since I work a 40 hr. week with 15 hrs. in commute time, I don't get to spend as much time on the site or on the forum as I would really like.

When I was first dx'd, I felt so alone until I found this forum and found encouraging, supportive, loving souls who reached out to help me along my journey. As a result, I felt from the beginning, a great desire to help others who will have to make that same trip.

Some wish to forget their experience as quickly as possible and talk about it minimally. But I talk with everyone I can about it because I think education is the key to making the best choices and also the key to remaining as healthy as we can. Stay in touch with us so we can follow your treatment plan and help out as needed. There is a wealth of knowledge and experience here and serious input.....so stay tuned in. Take care, Melodie

checkout:

www.bladdercancerwarrior.com/

The grand-lady put this site up to help us, and I have e-mailed her many times. What a help, she is!

Hello Tammy,

This is actually my second try at posting - hopefully this time it will go through.

I am a little over a year out from my surgery. I hope I can help in answering some of the questions you have. My help, comfort and fortitude came from this site and from Pat and Melodie who were my guides and angels.

I, like Pat, use disposable catheters. I use the 14French ColoPlast. I currently cath every 4-5 hours. My doctor said he would like to keep me at about 500 cc's but every once in awhile I take in too many liquids and have a whopping 700 cc's. I really try not to let this happen. Normally my output is between 300-400 cc's (I was not able to get this amount when I first started).

I cath standing up. I use Surgilube (individual packets/3 grams) and I cath into a plastic urinal. I also like to keep track of my output. If I'm out of the house or really busy I will cath into the toilet directly. I still flush twice a day with saline. I am not very coordinated so I have to sit to do this. Too much juggling. The flushing helps a lot since my mucous is now typically very light.

I cover my stoma with a Soft Sponge 2x2" (Invacare)- I find it more sturdy then guaze. I use Micropore tape to hold it on.

Cathing does not hurt but sometimes I must hit on a nerve and I can feel something not in the pouch but somewhere else in my abdomen. It happens rarely.

I have never experience feeling 'scabs' but there are two valves to get through.

I don't remember how long I was sore from the surgery - which is a good thing isn't it? I just remember that I focused on healing in the beginning.

Everyone of us is a little different. Other Indys have told me that they have contractions when they are full - I don't. I just have this feeling of fullness. I try to stay pretty much on schedule as far as cathing and don't rely on feeling anything.

I hope this helps somewhat Tammy. I am still learning and becoming use to my new life. It took me quite a while to be able to cath in public. I now have a purse that I can comfortably work out of.

I had no idea how I was going to be able to travel. Cath on a plane?? Yikes! I couldn't imagine. But recently I did travel and I managed to cath quite successfully. Did wonders for my confidence and made me feel so liberated. But its all one step at a time.

We will be here for you.

Best,
Gracie