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Thread: Where to get pristeen in California

  1. #11
    How many uses do you get out of the Peristeen catheters?

    If it's covered by insurance, than obviously go with it. They probably won't give you the unit unless they trained you, but I "trained" myself. You're just putting water in your colon. As long as you don't try and instill 5 gallons or something like radiator fluid it's not really rocket science

  2. #12
    I found the answer to Medicare coverage here: http://sci.rutgers.edu/forum/showthr...n-System/page2

    The thread dates back to 2014-16 and Medicare and Veterans Administration both cover Peristeen now.

    Possibly dating back to my rehab days, I remember a device called pulsed irrigation evacuation (PIE). At the time, I don't think the system had FDA approval and my gastroenterologist was worried about washing away the natural mucous of the colon. Is this a concern with either the PIE or Peristeen systems?

    Is the PIE system being used today? Pro and Con of PIE over Peristeen type systems?

    I read in the thread above that the PIE system required administration by an attendant while the patient is in bed, where as the Peristeen system can be used independently, if user is capable, and is administered while sitting on a toilet or commode chair. Have there been changes to these uses and administration?

  3. #13
    Senior Member
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    Quote Originally Posted by gjnl View Post
    I filled out the contact form at the Coloplast site and am awaiting a return call as well. I too am in the San Francisco Bay area. I suspect training centers will be University of San Francisco, Rehab center at Santa Clara and/or Stanford University Medical Center.

    Is Peristeen covered by Medicare?
    I was told a couple of weeks ago by the SCI nurse at Sharp San Diego that Peristeen is not covered by Medicare.
    T4 complete, 150 ft fall, 1966. Completely fused hips, partially fused knees and spine, heterotopic ossification. Unsuccessful DREZ surgery about 1990. Successful bladder augmentation using small intestine about 1992. Normal SCI IC UTI problems culminating in a hospital stay in 2001. No antibiotics or doctor visits for UTI since 2001: d-mannose. Your mileage may vary.

  4. #14
    Quote Originally Posted by gac3rd View Post
    I was told a couple of weeks ago by the SCI nurse at Sharp San Diego that Peristeen is not covered by Medicare.
    Quote Originally Posted by SCI-Nurse View Post
    No. I just had a meeting with our rep, and it still not VA approved, but it is finally Medicare approved, so you could ask you VA provider to prescribe product through you Medicare & then request the training through Fee-Basis. Coloplast will only supply after you have been trained by one of their certified RNs. They are busy training outpatient & inpatient RNs at larger non-VA rehab centers now.

    (KLD)
    Post Number 3 by SCI Nurse KLD
    Thread: http://sci.rutgers.edu/forum/showthr...n-System/page2
    Date: 12/03/2014

    Quote Originally Posted by SCI-Nurse View Post
    They are now on VA contract, but are pretty slow in rolling out to VA facilities, including SCI Centers. There is still a requirement (from the FDA) that they only be prescribed by providers who, and training provided by nurses who, have completed the Coloplast training program on the Peristeen. So not just any VA provider can order them for you...

    (KLD)
    Post Number 12 by SCI Nurse KLD
    Thread: http://sci.rutgers.edu/forum/showthr...n-System/page2
    11/22/16

    From article in New Mobility, April 1, 2014, http://www.newmobility.com/2014/04/p...el-management/

    Para/Medic: Peristeen: New Option for Bowel Management

    Most important now is getting insurance companies to understand the importance of the system so they will reimburse it, says Martini. Coloplast has applied for a Medicare HCPCS code for Peristeen. Approval is expected by November. When the code is granted, approval from other insurers will be much easier. At present the system is being approved in quite a few states through Medicaid and more are being added. Various private insurance companies are paying for it, but it may take a few appeal processes. As always, it is important to get documentation on why you need the system and get prior authorization. Coloplast is working with suppliers to help educate insurance companies on the importance of the system.

    I did an internet search to find a code. https://www.dmepdac.com/resources/articles/2015/02_18_15.html

    It appears that the system as initially provided with pump, balloon, catheter and accessories is initially covered, but refills for additional disposable supplies is not covered by Medicare.

    Correct Coding and Coverage – Peristeen? Transanal Irrigation (PAI) System

    Joint DME MAC Publication

    The Peristeen transanal irrigation (PAI) system is a device used to empty the lower bowel and to prevent chronic constipation and fecal incontinence or simply as a method of bowel management. The system consists of an enema bag, a rectal catheter with an inflatable balloon and a hand pump. Effective for claims with dates of service on or after January 1, 2015 the correct code to bill is:
    A4459 – MANUAL PUMP ENEMA SYSTEM, INCLUDES BALLOON, CATHETER AND ALL ACCESSORIES, REUSABLE, ANY TYPE
    There is no Medicare benefit for this device; therefore, claims for code A4459 will be denied as non-covered (no Medicare benefit).
    Code A4459 is an all-inclusive code at initial issue. Separate billing of any of the individual components is not allowed. The code is established as a single code to include all parts including the disposable supplies at initial issue. For refills of disposable supplies such as rectal catheters, HCPCS code A9270 (Noncovered item or service) should be used.
    For questions about correct coding, contact the PDAC Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form.
    Last edited by gjnl; 09-29-2017 at 02:14 PM.

  5. #15
    Quote Originally Posted by gjnl View Post
    I found the answer to Medicare coverage here: http://sci.rutgers.edu/forum/showthr...n-System/page2

    The thread dates back to 2014-16 and Medicare and Veterans Administration both cover Peristeen now.

    Possibly dating back to my rehab days, I remember a device called pulsed irrigation evacuation (PIE). At the time, I don't think the system had FDA approval and my gastroenterologist was worried about washing away the natural mucous of the colon. Is this a concern with either the PIE or Peristeen systems?

    Is the PIE system being used today? Pro and Con of PIE over Peristeen type systems?

    I read in the thread above that the PIE system required administration by an attendant while the patient is in bed, where as the Peristeen system can be used independently, if user is capable, and is administered while sitting on a toilet or commode chair. Have there been changes to these uses and administration?
    Check insurance coverage first, but after that I'd really consider lifestyle as well. That PIE system looks massive, like a radiator you have to keep in your bathroom. You want to lug this with you on vacation?


  6. #16
    I have not had any luck with a call back from coloplast, any thoughts on how to get this thing?

  7. #17
    Quote Originally Posted by emanshiu View Post
    I have not had any luck with a call back from coloplast, any thoughts on how to get this thing?
    I've emailed Coloplast twice....Crickets! Heard nothing.

    I read a thread here (http://sci.rutgers.edu/forum/showthr...ght=flowmaster) where a device named Flowmaster was recommended. Any one use this system? https://www.optimalhealthnetwork.com...nse-s/1026.htm
    Last edited by gjnl; 10-04-2017 at 12:49 PM.

  8. #18

  9. #19
    Quote Originally Posted by Davey View Post

    thank yo. Did all of you do the evaluation and training? It really is running through a lot fo hoops and costs just to try this. It seems almost cheaper to buy the system and try it. Thoughts?

  10. #20
    I just bought the unit, watched a few videos and tried it. Been working great for about two years now.

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