New Revascularization Codes for 2011

By Beth Browne, RN, MSN, NP, CCS

It is common for physicians to perform multiple peripheral vascular interventions in order to achieve the best clinical result. In the past, there has been confusion as to how (and if) multiple interventions should be reported based on language in the NCCI manual. Specifically, the NCCI Manual states that “when percutaneous angioplasty of a vascular lesion is followed at the same session by a percutaneous or open atherectomy….only the more comprehensive atherectomy that was performed…should be reported.” There have been significant changes to peripheral vascular intervention codes in the cardiovascular surgery section of CPT for 2011. In order to simplify reporting of multiple interventions in a single vessel, a new set of “revascularization” codes was added. In many cases, the new codes will allow for reporting of a single code where previously multiple codes were required.

New Codes for 2011

CPT Code Descriptor

37220 Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty

37221 Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed

37222 Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (list separately in addition to code for primary procedure)

37223 Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (list separately in addition to code for primary procedure)

37224 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty

37225 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed

37226 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed

37227 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed

37228 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty

37229 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed

37230 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed

37231 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed

37232 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (list separately in addition to code for primary procedure)

37233 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed (list separately in addition to code for primary procedure)

37234 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (list separately in addition to code for primary procedure)

37235 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed (list separately in addition to code for primary procedure)

The new codes simplify reporting of multiple peripheral vascular interventional procedures. As an example, in 2010, an angioplasty, stent, and atherectomy of the tibioperoneal artery could potentially be reported with three codes: 37205 + 35470 + 35495. While there are no NCCI edits to prevent reporting these three codes together, the NCCI manual created uncertainty as to the circumstances under which angioplasty and atherectomy may be reported together, if at all. In 2011, these three procedures, when performed at the same encounter, will be reported with the single code 37231, eliminating any uncertainty.

In addition to these changes, Category I CPT codes for atherectomy of vessels in other anatomic sites have been deleted and replaced by Category III CPT codes.

New Category III CPT Codes for 2011

CPT Code Descriptor

0234T Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; renal artery

0235T Transluminal peripheral atherectomy visceral artery ea long description: transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; visceral artery (except renal), each vessel

0236T Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; abdominal aorta

0237T Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; brachiocephalic trunk and branches, each vessel

0238T Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; iliac artery, each vessel

The open atherectomy codes 35480-35485 and percutaneous atherectomy codes 35490-35495 were deleted for 2011.

Medical Necessity Criteria for Radiopharmaceutical Agent Reimbursement

By Vicki Fry, MS, MBA

On August 28, 2010, Wisconsin Physicians Service Insurance Corporation (WPS), FI 52280, published Radiopharmaceutical Agents #RAD-026 V2 Approved DRAFT LCD. This draft LCD is one of the first, if not the first LCD, that establishes medical necessity criteria by specific CPT code procedure(s) for radiopharmaceutical agent reimbursement. The draft LCD Indications and Limitations of Coverage and/or Medical Necessity section indicates that radiopharmaceuticals will be considered medically necessary when used with the procedures listed in Table 1 (see below.)

Current CMS nuclear medicine procedure OCE edits require hospitals to include one of any HCPCS codes for a radiopharmaceutical agent when a separately payable nuclear medicine procedure is present on a claim. Therefore, OCE edits require hospitals to include a diagnostic or therapeutic radiopharmaceutical HCPCS code on the same claim as a nuclear medicine procedure for services provided beginning on January 1, 2008 in order to receive payment for the nuclear medicine procedure. While this OCE edit remains applicable, the WPS draft LCD adds criteria for the radiopharmaceutical HCPCS code reimbursement. It is unclear, however, if WPS will also deny payment for the nuclear medicine procedure if the radiopharmaceutical HCPCS code is denied when medical necessity is not established.

I recommend hospitals, with WPS FI 52280 as their FI, to review this draft LCD to assure consistency with their current nuclear medicine and radiopharmaceutical coding practices. The draft LCD comment period is 10/07/2010 to 11/21/2010. Additionally, hospitals should review the following nuclear medicine coding issues identified by a WPS claims review. The WPS claims review showed:

1. Incorrect coding /utilization for A9500 and A9502, A9503. These codes were being billed per mCi when these agents are to be billed once per study. a. WPS will allow up to 2 units of service will be allowed for A9500 and A9502. One unit of service will be allowed for A9503.

2. Cardiac blood pool imaging / gated Equilibrium studies (78472, 78473, 78494, and 78496) were submitted with incorrect radiopharmaceutical codes. a. WPS will allow A9560. HCPCS codes A9538 and A9512 will be denied when billed with these CPT codes.

Table 1. WPS Draft LCD Radiopharmaceutical Agent Indications and Limitations of Coverage and/or Medical Necessity

HCPCS CODE WPS RADIOPHARMACEUTICAL DESCRIPTION CPT CODE(S) PROCEDURE(S)

A9504 Technetium Tc-99m Apcitide (Acu Tect ®), diagnostic, per study dose, up to 20 millicuries 78456 Venous thrombosis study

A9568 Technetium Tc-99m Arcitumomab (CEA scan), Diagnostic, per study dose, up to 45 mCi's 78800-78804 Immunoscintigraphy, using single-photon emission computed tomography (SPECT)

A9557 Technetium Tc-99m Bicisate (Neurolite ®), Diagnostic, per study dose, up to 25 mCi's 78600-78607, 78610 Brain imaging

A9536 Technetium Tc-99M Depreotide, (Neotect ®) Diagnostic, per study dose, up to 35 mCi's 78000, 78001, 78003 Lung tumor/lesion detection

A9551 Technetium Tc-99m Succimer (DMSA), Diagnostic, per study dose, up to 10 mCi's 78700-78710 Parenchymal renal scan

78800-78804 Tumor detection

A9539 Technetium Tc-99m Pentetate, Diagnostic, per study dose, up to 25 mCi's 78580-78596 Lung ventilation

78761 Testicular imaging with vascular flow

78700-78725 GFR renal scan

78730 Urinary bladder residual

78740 Ureteral reflux

78630-78650 CSF study

78600-78607, 78610 Brain study

78291, 78645 Shunt patency agent. 500 uCi

78481, 78483 First-pass cardiac technique studies

A9567 Technetium Tc-99m Pentetate, Diagnostic, aerosol, per study dose, up to 75 mCi’s 78580-78596 Lung ventilation

A9510 Technetium Tc-99m Disofenin (Hepatolite ®, DISIDA), per study dose, up to 15 mCi's 78220, 78223 Hepatobiliary scan agent

A9521 Technetium Tc-99m Exametazine (Ceretec ®), Diagnostic, per study dose, up to 25 mCi’s 78600-78607, 78610 Brain perfusion

A9569 Technetium TC-99m Exametazime labeled autologous white blood cells, Diagnostic, per study dose 78805-78807 Infection detection

A9566 Technetium Tc-99m Fanolesomab, (NeutroSpec ®), Diagnostic, per study dose, up to 25 mCi’s 78805 Appendicitis detection

A9550 Technetium Tc-99m Sodium Gluceptate (Glucoheptonate ®), Diagnostic, per study dose, up to 25 mCi’s 78700-78725 Parenchymal renal scan

78805-78807 Infection detection

78600-78607, 78610 Brain imaging

A4641 TechnetiumTc-99m Human Serum Albumin, Usual Dosage 2-20 mCi 78630-78652 CSF Leak Study

78414-78458 Blood pool agent

78195 Lymphatic imaging

A4641 Technetium Tc-99m Iminodiacetic, Usual Dosage 5-12 mCi Acid (IDA) 78220, 78223 Hepatobiliary scan agent

A9540 Technetium Tc-99m Macroaggregated Albumin (MAA), Diagnostic, per study dose, up to 10 mCi’s 78580-78596 Lung perfusion agent

78291 Peritoneal-Venous Shunt Study

78216, 78428 Cardiac Shunt Detection

A9537 Technetium Tc-99m Mebrofenin (Choletec ®) Diagnostic, per study dose, up to 15 mCi's 78220, 78223 Hepatobiliary scan agent

A9562 Technetium Tc-99m Mertiatide (MAG-3), diagnostic, per study dose, up to 15 mCi's 78700-78725 Renal scan agent

A9503 Technetium Tc-99m, Medronate, (MDP), diagnostic, per study dose, up to 30 mCi's 78300-78320, 78399 Bone scan

A9561 Technetium Tc-99m Oxidronate, Diagnostic, per study dose, up to 30 mCi's 78300-78320, 78399 Bone scan agent

A9512 Technetium Tc-99m-Pertechnetate, Diagnostic, per mCi 78000-78001, 78006-78007, 78010, 78011, 78015 Thyroid study

78600-78607, 78610 Brain death

78481, 78483 First-pass cardiac technique studies

78261, 78290 Meckel’s diverticulum 10-20 mCi

78070 Parathyroid study

78230-78232 Parotid or salivary scan

78261-78290 Gastric mucosa

78730 Urinary bladder residual

78740 Ureteral reflux study

78660 Dacryocystography

78761 Testicular imaging with vascular flow

A9538 Technetium Tc-99m Pyrophosphate (PYP) (Pyrolite ®) Diagnostic, per study dose, up to 25 mCi's 78300-78320 Bone

78999 Amyloid imaging

78466-78469 Myocardial Infarct imaging

A9560 Technetium Tc-99m Labeled Red Blood Cell's (RBC's) Diagnostic, per study dose, up to 30 mCi’s (Ultra Tag ® or cold pyrophosphate (pyp) +99m technetium) 78472, 78473, 78494, 78496 Cardiac blood pool imaging / Gated Equilibrium studies

78278 GI bleed study

78201-78205 Liver scan (for Hemangioma)

78445 Vascular flow study

78457-78458 Venous thrombosis imaging

78215, 78216, 78185 Spleen imaging

A9500 Technetium Tc-99m, Sestamibi, diagnostic, per study dose 78451-78454 Cardiac perfusion

78070 Parathyroid study

78605-78607, 78800-78804 Tumor

78800, 78801 Breast tumor

A9541 Technetium Tc-99m Sulfur Colloid, Diagnostic, per study dose, up to20 mCi's 78201-78216 Liver spleen scans

78185 Spleen scan

78278 GI bleed studies

78102-78104 Bone marrow studies

78264, 78299 Gastric emptying, gastric emptying with colonic transit studies

78258, 78262 Gastroesophageal reflux studies

78740 Ureteral reflux study

78730 Urinary bladder residual study

78195 Lymphatics & Lymph glands

78291 Peritoneal-pleural shunt studies

A9502 Technetium Tc-99m tetrofosmin, diagnostic, per study dose 78451-78454 Myocardial perfusion studies

A4641 Hippurate (Orthoiodohippurate), Usual Dosage 150-250 uCi 78700-78725 Renogram

A9516 Iodine I-123 Sodium iodide capsule(s), Diagnostic per 100 Microcuries, up to 999 microcuries 78000-78018, 78020, 78070 Thyroid imaging

A9509 Iodine I-123 Sodium Iodide, diagnostic, per millicurie 78000-78018, 78020, 78070 Thyroid imaging

A9582 Iodine i-123 Iobenguane, diagnostic, per study dose, up to 15 millicuries AdreView ®) 78075 Adrenal imaging/ Pheochromocytoma

78800-78804 Neuroblastoma imaging

A9554 Iodine-125 Sodium Iothalamate (Glofil-125 ®), Diagnostic, per study dose, up to 10 microcuries 78707-78709, 78725 Renogram

A9532 Iodinated I-125-Serum Albumin, Diagnostic, per 5 microcuries 78110-78111, 78122 Plasma Volume

A9527 Iodine- 125 Sodium Iodide solution, Therapeutic, per millicurie 79005 Hyperthyroidism or thyroid cancer

A4641 Hippurate (Orthoiodohippurate),Usual Dosage 150-250 uCi 78707-78709, 78725 Renogram

A9508 Iobenguane sulfate-Metaiodobenzyl guanidine (MIBG) per 0.5 mCi 78075 Adrenal imaging/Pheochromocytoma

78800-78804 Neuroblastoma imaging

A9517 Iodine I-131 Sodium Iodide capsule(s), Therapeutic, per mCi 79005 Hyperthyroidism or thyroid cancer

A9530 Iodine I-131 Sodium Iodide solution, Therapeutic, per mCi 79005 Hyperthyroidism or thyroid cancer

A9528 Iodine I-131 Sodium Iodide capsule(s), Diagnostic, per mCi 78000-78018 Thyroid uptake and imaging

A9529 Iodine I-131 Sodium Iodide solution, Diagnostic, per mCi 78000-78018 Thyroid uptake and imaging

A9531 Iodine I-131 Sodium Iodide, Diagnostic, per microcurie (up to 100 microcuries) 78000-78018 Thyroid uptake and imaging

A9544 Iodine I-131 Tositumomab, (Bexxar ®) Diagnostic, per study dose 78804 Tumor imaging

A9545 Iodine I-131 Tositumomab, (Bexxar ®) Therapeutic, per treatment dose 79403 Radiopharmaceutical therapy, radiolabeled monoclonal antibody by IV infusion

A9524 Iodinated I-131-Serum Albumin, diagnostic, per 5 microcuries 78110-78111, 78122 Plasma Volume

78600-78607, 78610 Brain imaging

78580-78596 Pulmonary perfusion imaging

78451-78454 Cardiac imaging

78800-78804 Tumor imaging

78472-78473, 78481-78483 Cardiac Blood Pooling imaging

A9507 Indium IN 111 Capromab Pendetide (ProstaScintâ) per study dose, up to 10 mci's 78800-78804 Tumor detection

A4641 Indium -111 Diethylenetriamine Pentaacetic acid (DTPA), Usual Dosage 500 uCi 78630-78650 Cisternography or CSF leak detection, or shunt patency evaluation

78264 Gastric emptying

A9548 Indium IN-111 Pentetate (MyoScint ®) Diagnostic, per 0.5 mCi 78800-78803 Detecting myocardial injury

A9547 Indium-IN-111 Oxyquinoline, Diagnostic, per 0.5 mCi 78805-78807, 78185 Leukocyte labeling

78190-78191, 78199 Platelet labeling

A9572 Indium-111 Pentetreotide (OctreoScan ®), Diagnostic, per study dose, up to 6 millicuries 78075, 78800-78804, 78015-78018 Agent for localization of primary and metastatic neuroendocrine tumors bearing somatostatic receptors

A4642 Indium-111 Satumomab pendetide, diagnostic, per study dose, up to 6 mci's (OncoScint ®) 78800-78804 Agent for imaging colorectal or ovarian cancers

A9542 Indium-IN-111 Ibritumomab Tiuxetan, Diagnostic, per study dose, up to 5 mCi's (Zevalin ®) 78804 Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent (s); whole body, requiring 2 or more days imaging

A9543 Yttrium-90 Ibritumomab Tiuxetan, Therapeutic, per treatment dose, up to 40 mCi's 79403 Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion

A4641 Indium-111 Hydrochloride (HCL) Usual dosage 0.1-1.0 mCi 78299 Gastric emptying with colonic transit study

A9570 Indium-111 labeled autologous white blood cells, diagnostic, per study dose 78805-78807, 78185 Leukocyte labeling

A9571 Indium in-111 labeled autologous platelets, diagnostic, per study dose 78190-78191, 78199 Platelet labeling

A9546 Cobalt CO-57-/58 Cyanocobalamin, Diagnostic, per study dose, up to 1 microcurie 78270-78272 For measurement of vitamin B12 absorption. (Schilling Test)

A9559 Cobalt CO-57 Cyanocobalamin, oral, Diagnostic, per study dose, up to 1 microcurie 78270-78272 For measurement of vitamin B12 absorption. (Schilling Test)

A9553 Chromium CR-51 Sodium Chromate, Diagnostic, per study dose, up to 250 microcuries 78120-78122 RBC Mass

78130-78135, 78140 RBC Survival

78190-78191 Platelet Survival

A9556 Gallium Ga-67 Citrate, Diagnostic, per mCi 78800-78807 Used in scans searching for infections, inflammation, tumors

78999 Sarcoidosis

A9564 Chromic Phosphate P-32, suspension, Therapeutic, per mCi 79200 Therapeutic imaging agent for treatment of ovarian cancer

79300-79445 Interstitial radioactive colloid therapy

A9563 Sodium Phosphate P-32, Therapeutic, per mCi 79101 Therapeutic imaging agent for treatment of polycythemia vera or thrombocythemia

A9600 Strontium SR-89 Chloride (Metastron ®), Therapeutic, per mCi 79101 Therapeutic for treatment of bone pain due to skeletal metastases

A9604 Samarium SM-153 Lexidronam (Quadramet ®) Therapeutic, per treatment dose up to 150 millicuries 79101 Therapeutic for the treatment of pain in patients with confirmed osteoblastic metastatic bone lesions that enhance on radionuclide bone scan

A9505 Thallous Chloride TL-201, diagnostic, per mCi 78451-78454 Cardiac imaging

78070 Parathyroid imaging

78800-78804 Tumor imaging

A9558 Xenon Xe-133 Gas, Diagnostic, per 10 mCi’s 78591-78594, 78596 Lung ventilation study

78580-78588 Pulmonary perfusion imaging

A9555 Rubidium RB-82 PET Scan codes PET Scans

A9552 Fluorodeoxyglucose (F-18 FDG) PET Scan codes PET Scans

A9526 Ammonia N-13 PET Scan codes PET Scans

AMA Coding Guidance:

September 2010 CPT Assistant

By Jennifer Ridell, CPC

Coding Communication: Manual and Mechanical Chest Wall Manipulation

CPT codes 94667 and 94668 can be used to report either manual or mechanical chest wall manipulation that will help facilitate the clearing of airway secretions. Code 94667 describes the initial procedure of bronchial therapy; this procedure is used to stabilize the patient and to train family members on the proper delivery of manual chest wall manipulation techniques. Code 94668 is to be used to report additional visits for provider assisted therapy that usually last for 30 minutes. If a patient is provided with a patient-controlled device used for chest wall manipulation, code 94668 should not be reported and instead 99070 or HCPCS code E0483 should be used. There are two other CPT codes that can be reported for specific procedures used to help clear airway secretions and they are small hand-held, flow-operated inhaler devices (94664) and intrapulmonary percussive ventilation (94640).

Coding Brief: Observation Care Scenarios

There are three codes that should be considered when reporting initial observation care. CPT codes 99217 - 99220 cover discharge services and three levels of initial observation care. CPT code 99217 covers discharge services but should only be reported if the discharge occurs on a day other than the initial day of admittance for observation care. CPT codes 99218 - 99220 cover varying levels (low, moderate, and high severity) of initial observation care. If the physician who initiates the observation care requests an additional physician to evaluate the patient, only the initiating physician can report the initial observation care codes, the second physician must report the appropriate new or established patient office or other outpatient visit codes.

Use of CPT Modifiers 76, 78, and 79

CPT modifiers are used to convey information to third-party payers that a specific circumstance altered a specific service or procedure but did not ultimately change the intent of the procedure or service. It is important to convey as much information to third-party payers as possible to ensure proper reimbursement and unnecessary denial of claims. Modifiers are used to properly describe special circumstances that occurred during the patient's treatment. CPT modifiers 76, 78 and 79 cover the following scenarios:

CPT Modifier 76: This modifier is used to communicate that a specific service or procedure was repeated, possibly on the same day, to eliminate the chance of a bill being marked as a duplicate by a third-party payer. This modifier may be used by physicians and hospitals. Hospital outpatient bills may also include this modifier but if the bill covers any laboratory or pathology procedures then this modifier should not be reported.

CPT Modifier 78: This modifier is used in cases where the patient was returned to the operating room for a separate unplanned procedure by the same surgeon following the initial procedure. This modifier should not be used for staged or related procedures, only unplanned procedure possibly resulting from a complication from the initial procedure.

CPT Modifier 79: This modifier is used in cases where a patient needs a second, unrelated procedure, performed by the same physician during the postoperative period of another procedure. Modifier 79 would be appended to the procedure code for the subsequent procedure and a new global period would begin.

A list of modifiers is available in Appendix A of the CPT code book.

Coding for Clostridium difficile

CPT code 87493 was created in 2010 to describe the technique used to detect the presence of Clostridium difficile (C. difficile). C. difficile is an infectious bacteria mainly impacting patients with irritable bowel or ulcerative colitis in hospitals or long-term care settings, but it has recently been identified as a source of community-associated diarrhea. Specifically, the description associated with 87493 is: infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile, toxin gene(s), amplified probe technique. This test may be performed in multiple types of laboratories, including, independent or reference, physician's office, or hospital laboratories.

Coding Consultation: Questions and Answers

An article by the CPT Editorial Panel answers questions posed to the panel regarding the subjects of medicine/health and behavior assessment/intervention, special otorhinolaryggologic services, and opthalmology, surgery/musculoskeletal system, digestive system, integumentary system, nervous system, and respiratory system, and Appendix I: Genetic Testing Code Modifiers. The responses answer multiple questions including: CPT codes 28285, 28270, and 28234 were all reported for surgery on a single toe. Are the procedures reported by codes 28270 and 28234 included in code 28285 and would it be appropriate to code a visual field test (code 92081) twice when performing it once with eyelids taped and once without eyelids taped?

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 “September 2010.”

Code Set Updates

HCPCS annual update reminder

CMS has issued a reminder that the annual update of the HCPCS data file will be available via the CMS mainframe telecommunication system after 8 PM Eastern time, on October 27, 2010. HCPCS codes are used by Medicare providers to report services provided on claims submitted to Medicare contractors. HCPCS consists of Level-I CPT codes from the American Medical Association and the Level-II alpha numeric codes maintained by CMS. Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 2037, Aug. 27, 2010.

This transmittal can be viewed at ¶159,227 in the September 7, 2010, CCH Coding Comply What’s New newsletter; or on Rex via The Coding Suite in the CMS Manuals section under the title “R2037CP 2011 Healthcare Common Procedure Coding System (HCPCS) Annual Update Reminder.”

General Coding News

Billing reminders for the 2010 influenza and pneumococcal season

CMS has issued a general reminder of requirements for billing influenza and pneumococcal (PPV) vaccines as flu season approaches. Neither vaccine, influenza or PPV, requires a physician's order or supervision. The PPV vaccine is normally administered once in a beneficiary’s lifetime. A claim for a PPV vaccine will be paid for benficiaries that are considered high risk for contracting the disease and have not had a vaccination in the previous five years or if they happen to be unsure of their PPV vaccination status. Providers are also being reminded to use the correct CPT code for both vaccines and the appropriate HCPCS code for the actual administration of the vaccines. HCPCS code G0008 should be used for influenza and G0009 is used for PPV. One-Time Notification Manual, Pub. 100-20, Transmittal No. 774, Sept. 24, 2010.

This transmittal can be viewed at ¶159,265 in the October 4, 2010, CCH Coding Comply What’s New newsletter; or on Rex via The Coding Suite in the CMS Manuals section under the title “R774OTN 2010 Reminder for Roster Billing and Centralized Billing for Influenza and Pneumococcal Vaccinations.”

Suspension of automatic denial of institutional claims reporting modifier GA

In October 2009 CMS issued instructions for automatic denial of institutional claims with the GA modifier. This transmittal was then rescinded and replaced by Transmittal 1894 (January 2010) and finally by Transmittal 1921 (February 2010). Since these transmittals were released, acting on concerns from providers, CMS has asked Medicare contractors to suspend the automatic denial of institutional claims with the GA modifier. This instruction was effective April 1, 2010 and is still in place today as CMS reviews their recommended policy of automatic denial. One-Time Notification Manual, Pub. 100-20, Transmittal No. 770, Sept. 17, 2010.

This transmittal can be viewed at ¶159,259 in the October 4, 2010, CCH Coding Comply What’s New newsletter; or on Rex via The Coding Suite in the CMS Manuals section under the title “R770OTN Suspension of Automatic Denial of Institutional Claims Reporting Modifier -GA.”

Allogeneic hematopoietic stem cell transplantation for Myelodysplastic Syndrome

In 2009 CMS received a request from cancer and bone marrow organizations to consider allogeneic hematopoietic stem cell transplantation (HSCT) for Medicare patients with a high risk of progression to leukemia or Myelodysplastic Syndrome (MDS) complications. CMS did not find enough evidence to support improved health outcomes from the use of allogeneic HSCT in patients with MDS. CMS determined that allogeneic HSCT was not a reasonable or necessary treatment for patients with MDS. However, beginning August 4, 2010, using allogeneic HSCT for the treatment of MDS is reasonable and necessary if provided pursuant to a Medicare approved clinical study under Coverage with Evidence Development (CED).

When submitting a claim with HSCT for MDS, clinical trial coding conventions are required to identify that the claim falls into the clinical study under CED category. Inpatient Hospital Claims should have value code D4 and the 8-digit clinical trial number, ICD-9 diagnosis codes 238.75 and V70.7, applicable ICD-9-CM procedure codes and condition code 30. Professional and Outpatient hospital claims should have ICD-9 diagnosis codes 238.75 and V70.7, HCPCS modifier Q0, and applicable HCPCS or ICD-9-CM diagnosis or procedure codes, and the 8-digit clinical trial number. Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 2062, Oct. 8, 2010.

This transmittal can be viewed at ¶159,283 in the October 4, 2010, CCH Coding Comply What’s New newsletter; or on Rex via The Coding Suite in the CMS Manuals section under the title “R2062CP Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for Myelodysplastic Syndrome (MDS).”

NOTE: To follow the MediRegs links above, you will need to be a subscriber to the Coding Suite of products and if prompted, enter your username and password. If you cannot remember your user name or password go to: http://wk.mediregs.com/login_fs.html and the system will let you request a reminder. For the Internet Research Network or IntelliConnect links, you will need to be a subscriber to the CCH Coding Comply.

Requests for information about article submission and comments from readers are welcome and should be directed to at Nicole Stone at Nicole.Stone@wolterskluwer.com, Fax 847-267-2514. Customer service inquiries should be directed to 800-449-9525. CCH Coding Compliance Advisor is published monthly by CCH, a Wolters Kluwer business.

©2010 CCH. All rights reserved. No claim is made to original government works; however, the gathering, compilation, and arrangement of such materials, the historical, statutory and other notes and references, as well as commentary and materials in this Publication are subject to CCH copyright. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the publisher is not engaged in rendering legal, accounting or other professional service. If legal advice or other expert assistance is required, the services of a competent professional should be sought. For more information about the The Coding Suite or CCH Health Care Portfolio, please visit our online store at http://mediregs.com or http://health.cch.com.

You are subscribed to CCH® NetNews, sponsored by CCH INCORPORATED. Click here to unsubscribe. To manage your newsletter preferences or subscribe, click here.

To unsubscribe via postal mail, please contact us at: CCH, Attn: Business Compliance Marketing, 2700 Lake Cook Rd., Riverwoods, IL 60015. Please include the email address you have been contacted with.

October 2010 Edition

Hot Topics:

AMA Coding Guidance:

Code Set Updates:

General Coding News:

Hot Topics:

New Revascularization Codes for 2011

Medical Necessity Criteria for Radiopharmaceutical Agent Reimbursement

AMA Coding Guidance:

September 2010 CPT Assistant

Coding Communication: Manual and Mechanical Chest Wall Manipulation

Coding Brief: Observation Care Scenarios

Use of CPT Modifiers 76, 78, and 79

Coding for Clostridium difficile

Coding Consultation: Questions and Answers

Code Set Updates

HCPCS annual update reminder

General Coding News

Billing reminders for the 2010 influenza and pneumococcal season

Suspension of automatic denial of institutional claims reporting modifier GA

Allogeneic hematopoietic stem cell transplantation for Myelodysplastic Syndrome

Subscribe to Newsletter

Managing Editor’s Note

About the Authors

Webinars