Three Way Indwelling Catheter and Continuous Irrigation of Indwelling Catheter
A three way indwelling catheter either alone or with other components may be considered medically necessary only if continuous catheter irrigation is medically necessary. In other situations, a three way indwelling catheter will be considered not medically necessary.
Supplies for continuous irrigation of a catheter may be considered medically necessary if there is a history of obstruction of the catheter and the patency of the catheter cannot be maintained by intermittent irrigation and catheter changes.
Supplies for medically necessary continuous bladder irrigation include a 3-way Foley catheter, irrigation tubing set, and sterile saline or sterile water.
More than one set of irrigation tubing per day, for continuous catheter irrigation, will be considered not medically necessary.
Therapeutic irrigation solutions containing antibiotics and chemotherapeutic agents are considered experimental/investigational because their value is unproven.
Irrigating solutions such as acetic acid or hydrogen peroxide, which are used for the treatment or prevention of urinary obstruction, are of no proven value and are considered experimental/investigational.
Sterile water or sterile saline may be considered medically necessary for use as irrigation solutions.
Continuous irrigation is a temporary measure; continuous irrigation for more than two (2) weeks is rarely considered medically necessary and will be considered not medically necessary when there is no supporting medical documentation
Any other indication not listed above will be denied as not medically necessary.