December 2010 CPT Assistant

   By Jennifer Ridell, CPC

New CPT Modifier for Preventative Services

The Patient Protection and Affordable Care Act of 2010 requires all health insurance plans to begin covering preventative services and immunizations without any cost sharing requirements. Cost sharing requirement would mean co-pays, coinsurance, or deductible. If the preventative services are part of an office visit then the office visit may not have cost sharing if the primary reason for the visit is the preventative service. If the office visit and preventative service are billed separately and the primary reason for the office visit was not the preventative service then cost sharing is permitted for the office visit.

To better facilitate proper claim processing for preventative services, CPT modifier 33 has been created. This new modifier is effective January 1, 2011 and should be used when the primary purpose of the service is the delivery of an evidence-based service in accordance with a US Preventative Services Task Force A or B rating or other services identified in preventative services mandates (legislative or regulatory).

Pathology and Laboratory Changes in CPT 2011

The CPT 2011 code book included many changes to the pathology and laboratory services sections. The changes included moving codes from the pathology and laboratory section to the digestive system section. The specific sections and codes where there were changes include: Drug Testing (CPT code 80104), Chemistry (82930, 82952, 83861, and 84112), Hematology and Coagulation (85597 and 85598), Immunology (86480 and 86481), Transfusion Medicine (86902), Microbiology (87501, 87502, 87503, 87901, and 87906), Cytopathology (88120, 88121, 88172 and 88177), Surgical Pathology (88332, 88334 and 88363), In Vivo (eg, Transcutaneous) Laboratory Procedures (88749) and Gastric Intubation and Aspiration Codes (43754, 43755, 43756 and 43757).

Coding Communication: Nanoliter Volume Tear Fluid Testing on a Microfluidic Lab-on-a-Chip

Advancements in laboratory technology now allow for small volume specimen analysis. The CPT 2011 Codebook includes a new code for this procedure, 83861, microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity. The code is used to report the new procedure, Nanoliter Volume Tear Fluid Testing on a Microfluidic Lab-on-a-Chip, that is helping with treatment for dry eye disease. CPT code 83861 should be reported twice when testing is performed bilaterally with modifier 59 appended to the code for the second eye.

Coding Consultation: Questions and Answers

An article by the CPT Editorial Panel answers questions posed to the panel regarding the subjects of surgery/musculoskeletal, endocrine, cardiovascular, digestive, ophthalmology, nervous and respiratory systems, radiology, medicine/neurology, pulmonary, chemotherapy administration, and Modifier 59. The responses answer multiple questions including: is it appropriate to report code 47801, Placement of choledochal stent, for the insertion of a Turcotte tube performed at the time of a liver transplant and please describe the procedure represented by code 74420, Urography, retrograde, with or without KUB, and the appropriate reporting when performed through a cystoscope.

To view these articles via CCH Coding Comply, search from the Search Code Sets tab in Coding Comply for any of the codes listed above, view the Related Documents by clicking on the paper icon next to the code, then select the article. To view these articles in The Coding Suite, go to the CPT Assistant Archives folder and in the Search field within this folder and enter “December 2010.”

General Coding News

2011 Medicare Physician Fee Schedule summary of policies and the telehealth originating site facility fee payment amount

CMS has released a summary of the policies included in the calendar year 2011 Medicare Physician Fee Schedule (MPFS) Final Rule along with the payment information for the telehealth originating site facility fee.

The telehealth originating site facility fee increases on the first day of the year by the percentage increase in the Medicare Economic Index which was 0.4 percent for 2011. This translates to a payment amount for HCPCS code Q3014 of 80 percent of the lesser of the charge or $24.10.

The calendar year 2011 MPFS Final Rule covered new policies for covering annual wellness visits (HCPCS codes G0438 and G0439), a new incentive payment for primary care practitioners covering HCPCS codes 99201-99215, 99304-99340 and 99341-99350 and increased payment for bone density tests (CPT® codes 77080 and 77082). Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 2129, Dec. 29, 2010.

This transmittal can be viewed at ¶159,421 in the January 11, 2011, CCH Coding Comply What’s New newsletter; or on Rex via The Coding Suite in the CMS Manuals section under the title “R2129CP Summary of Policies in the CY 2011 Medicare Physician Fee Schedule (MPFS) and the Telehealth Originating Site Facility Fee Payment Amount.”

Updated payment policies for standard power wheelchairs

The Patient Protection and Affordable Care Act of 2010 established new guidelines for payment of standard power wheelchairs in Section 3136. Previously, providers were required to allow beneficiaries to receive a standard power wheelchair on either a lump sum purchase basis or a monthly rental basis. When beneficiaries chose the lump sum purchase option, the claim for the wheelchair was required to have the HCPCS modifier NU (purchase of new equipment) or UE (purchase of used equipment) and claims for rental equipment are submitted with RR.

Beginning January 1, 2011 beneficiaries can no longer use the lump sum purchase option for standard power wheelchairs. This applies to power wheelchairs in Group 1 and Group 2 wheelchairs without additional power options. The HCPCS codes impacted by this change include K0813 - K0831 and K0898. Claims with dates of service after January 1, 2011, any of the HCPCS codes mentioned and modifiers NU or NE should be denied.

These changes do not include complex rehabilitative power wheelchairs or standard power wheelchairs for beneficiaries in the nine competitive bidding areas of Round 1 Rebid of the DMEPOS competitive bidding program with dates of service between January 1, 2011 and December 31, 2013. One-Time Notification Manual, Pub. 100-20, Transmittal No. 786, Oct. 15, 2010.

This transmittal can be viewed at ¶159,434 in the January 24, 2011, CCH Coding Comply What’s New newsletter; or on Rex via The Coding Suite in the CMS Manuals section under the title “R786OTN Elimination of Lump Sum Purchase Payment for Standard Power Wheelchairs Furnished on or after January 1, 2011 due to the Affordable Care Act (ACA).”

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