Codingahead

Cardiac Resynchronization Therapy - ASC Payment details for CY 2012

2012-01-15T01:34:00.001-05:00

Effective for services furnished on or after January 1, 2012, cardiac resynchronization therapy involving an implantable cardioverter defibrillator (CRT-D) will be recognized as a single, composite service combining implantable cardioverter defibrillator procedures (described by Current Procedural Terminology (CPT) code 33249 (Insertion or repositioning of electrode lead(s) for single or dual chamber pacing cardioverter-defibrillator and insertion of pulse generator)) and pacing electrode insertion procedures (described by CPT code 33225 (Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator (including upgrade to dual chamber system))) when performed on the same Date of Service in an ASC.

The payment rate for CRT-D services in ASCs will be based on the OPPS payment rate applicable to APC 0108 and ASCs will use the HCPCS Level II G-code G0448 (Insertion or replacement of a permanent pacing cardioverter-defibrillator system with transvenous lead(s) single or dual chamber with insertion of pacing electrode, cardiac venous system, for left ventricular pacing) for proper reporting when the procedures described by CPT codes 33225 and 33249 are performed on the same Date of Service. When these procedures are not performed on the same Date of Service, the ASC payment rate will be based on the standard APC assignment for each service and ASCs should report the appropriate CPT codes for the individual procedures.

Reference: http://www.cms.gov/MLNMattersArticles/downloads/MM7682.pdf

2012 List of Deleted Lab codes

2012-01-15T01:32:00.000-05:00

88107 Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears and filter preparation with interpretation

88318 Determinative histochemistry to identify chemical components (eg, copper, zinc)

The Medicare EHR Incentive Program - Important informations

2012-01-14T12:15:00.002-05:00

February 29, 2012 – Last day for eligible professionals to register and attest to receive an Incentive Payment for calendar year (CY) 2011.To get the maximum incentive payment, Medicare eligible professionals must begin participation by 2012. The maximum bonus for eligible professional is $44,000 for Medicare and $63,750 for Medicaid.

Professionals who are eligible to receive Medicare EHR incentives

Doctors of Medicine or Osteopathy

Doctors of Dental Surgery or Dental Medicine

Doctors of Podiatric Medicine

Doctors of Optometry

Chiropractors

Please note: EPs may NOT be hospital-based. This is defined as any provider who furnishes 90% or more of their services in a hospital setting (inpatient or emergency room).

Professionals who are eligible to receive Medicaid EHR incentives

Physicians

Nurse Practitioners

Certified Nurse - Midwife

Dentists

Physicians Assistants who practice in a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) that is led by a Physician Assistant.

Please note: Medicaid EPs must also:

Have a minimum of 30% Medicaid patient volume (20% minimum for pediatricians), OR

Practice predominantly in a FQHC or RHC and have at least 30% patient volume to needy individuals.

*EPs can receive the maximum incentives by Choosing Medicaid EHR program.*

FAQs

Is my practice eligible to receive incentive payments through the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs?

Incentive payments are not made to practices but to individual eligible professionals (EPs). For more information about who is eligible to participate, please visit http://www.cms.gov/EHRIncentivePrograms/15_Eligibility.asp#TopOfPage.

Can eligible professionals (EPs) receive electronic health record (EHR) incentive payments from both the Medicare and Medicaid programs?

Not for the same year. If an EP meets the requirements of both programs, they must choose to receive an EHR incentive payment under either the Medicare program or the Medicaid program. After a payment has been made, the EP may only switch programs once before 2015.

What is the maximum incentive an eligible professional (EP) can receive under the Medicaid Electronic Health Record (EHR) Incentive Program?

EPs who adopt, implement, upgrade, and meaningfully use EHRs can receive a maximum of $63,750 in incentive payments from Medicaid over a six year period (Note: There are special eligibility and payment rules for pediatricians). EPs must begin receiving incentive payments by calendar year 2016. Know more....

KNOW THE ADVANTAGES OF EHR...Get started registering at https://ehrincentives.cms.gov/hitech/login.action

Annual alcohol screening - New HCPCS codes G0442 and G0443

2012-01-10T13:22:00.002-05:00

Effective for claims with dates of service October 14, 2011, and later, CMS would cover annual alcohol screening, and for those that screen positive, up to four, brief, face-to-face behavioral counseling interventions per year for Medicare beneficiaries, including pregnant women:

• who misuse alcohol, but whose levels or patterns of alcohol consumption do not meet criteria for alcohol dependence (defined as at least three of the following: tolerance, withdrawal symptoms, impaired control, preoccupation with acquisition and/or use, persistent desire or unsuccessful efforts to quit, sustains social, occupational, or recreational disability, use continues despite adverse consequences); and,

• who are competent and alert at the time that counseling is provided; and,

• whose counseling is furnished by qualified primary care physicians or other primary care practitioners in a primary care setting.

HCPCS codes and effective date

Two new G codes, G0442 (Annual Alcohol Misuse Screening, 15 minutes), and G0443 (Brief face-to-face behavioral counseling for Alcohol Misuse, 15 minutes), are effective October 14, 2011, and will appear in the January quarterly update of the Medicare Physician Fee Schedule Database (MPFSDB) and Integrated Outpatient Code Editor (IOCE). For claims with Dates of Service on or after October 14, 2011, through December 31, 2011, Medicare contractors will use their pricing to pay for G0442 and/or G0443.

Deductible and coinsurance do not apply.

Applicable POS

For purposes of this covered service, the following place of service (POS) codes are applicable:

11-Physician’s Office

22-Outpatient Hospital

49-Independent Clinic

71-State or local public health clinic

Can we bill both G0442 and G0443 on the same day?

Medicare will allow payment for both G0442 and G0443 on the same date (except in RHCs and FQHCs), but will not pay for more than one G0443 service on the same date.

Coverage Limitations

Medicare will track payments for G0442 screening services and G0443 counseling services so as to not permit payment for G0442 more than once in a 12-month period, and for G0443 no more than 4 times in a 12-month period, beginning with the date of the G0442 service.

How to bill for Incomplete Colonoscopies? Can we report CPT 45330 for incomplete colonoscopies?

2012-01-08T11:45:00.000-05:00

An incomplete colonoscopy, for example, the inability to extend beyond the splenic flexure, is billed and paid using colonoscopy code 45378 with modifier “-53.” The Medicare physician fee schedule database has specific values for code 45378-53. These values are the same as for code 45330, sigmoidoscopy, as failure to extend beyond the splenic flexure means that a sigmoidoscopy rather than a colonoscopy has been performed. However, code 45378-53 should be used when an incomplete colonoscopy has been done and not CPT code 45330 since the MPFSDB (Medicare Physician Fee Schedule Database) indicators are different for codes 45378 and 45330.

2012 New and Deleted Q codes list

2012-01-08T11:00:00.001-05:00

Added Q - Codes

Q0162 Ondansetron 1 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q2043 Sipuleucel-T, minimum of 50 million autologous cd54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion (effective 07/01/11)

Q4122 Dermacell, per square centimeter

Q4123 AlloSkin RT, per square centimeter

Q4124 Oasis ultra tri-layer wound matrix, per square centimeter

Q4125 Arthroflex, per square centimeter

Q4126 Memoderm, per square centimeter

Q4127 Talymed, per square centimeter

Q4128 FlexHD or AlloPatchHD, per square centimeter

Q4129 Unite Biomatrix, per square centimeter

Q4130 Strattice TM, per square centimeter

Deleted Q - codes

Q0179 Ondansetron hydrochloride 8 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q2040 Injection, incobotulinumtoxin a, 1 unit

Q2041 Injection, von Willebrand factor complex (human), Wilate, 1 i.u. VWF:RCO

Q2042 Injection, hydroxyprogesterone caproate, 1 mg

Q2044 Injection, belimumab, 10 mg

Also see list of added and Deleted G codes

2012 New and Deleted G codes

2012-01-08T10:49:00.002-05:00

Added G - codes

G0442 Annual alcohol misuse screening, 15 minutes (effective 10/17/11)

G0443 Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes (effective 10/17/11)

G0444 Annual depression screening, 15 minutes (effective 10/14/11)

G0445 High intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes (effective 11/08/11)

G0446 Intensive behavioral therapy to reduce cardiovascular disease risk, individual, face-to-face, bi-annual, 15 minutes (effective 11/08/11)

G0447 Face-to-face behavioral counseling for obesity, 15 minutes (effective 11/29/11)

G0448 Insertion or replacement of a permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber with insertion of pacing electrode, cardiac venous system, for left ventricular pacing

G0449 Annual face-to-face obesity screening, 15 minutes (effective 11/29/11)

G0450 Screening for sexually transmitted infections, includes laboratory tests for chlamydia, gonorrhea, syphilis and hepatitis b (effective 11/08/11)

G0451 Development testing, with interpretation and report, per standardized instrument form

G9156 Evaluation for wheelchair requiring face to face visit with physician

Deleted G - codes

G0440 Application of tissue cultured allogeneic skin substitute or dermal substitute; for use on lower limb, includes the site preparation and debridement if performed; first 25 sq cm or less

G0441 Application of tissue cultured allogeneic skin substitute or dermal substitute; for use on lower limb, includes the site preparation and debridement if performed; each additional 25 sq cm

G9041 Rehabilitation services for low vision by qualified occupational therapist, direct one-on-one contact, each 15 minutes

G9042 Rehabilitation services for low vision by certified orientation and mobility specialists, direct one-on-one contact, each 15 minutes

G9043 Rehabilitation services for low vision by certified low vision rehabilitation therapist, direct one-on-one contact, each 15 minutes

G9044 Rehabilitation services for low vision by certified low vision rehabilitation teacher, direct one-on-one contact, each 15 minutes

Please see complete list of 2012 CPT code changes

2012 Evaluation and Management services - Revised code list

2012-01-08T10:22:00.002-05:00

99218 Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to "observation status" are of low severity. Physicians typically spend 30 minutes at the bedside and on the patients hospital floor or unit

99219 Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to "observation status" are of moderate severity. Physicians typically spend 50 minutes at the bedside and on the patients hospital floor or unit

99220 Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to "observation status" are of high severity. Physicians typically spend 70 minutes at the bedside and on the patients hospital floor or unit

Please see complete list of 2012 CPT code changes

2012 Medicare Fee Schedule

2012-01-08T10:16:00.002-05:00

"2012 Medicare claims will be in hold till January 18, 2012"

According to section 301 of the TPTCCA (Temporary Payroll Tax Cut Continuation Act of 2011) prevents a payment cut for physicians that would have taken effect on January 1, 2012. An update of zero percent is effective for claims with dates of service January 1, 2012, through February 29, 2012. While the physician fee schedule update will be zero percent, other changes to the relative value units used to calculate the fee schedule rates must be budget neutral. To make those changes budget neutral, the conversion factor must be adjusted for 2012. CMS is currently developing the 2012 Medicare Physician Fee Schedule (MPFS) to implement the zero percent update. As previously advised, Medicare claims administration contractors will be holding new, January 2012 claims for up to 10 business days in order to effectively test and implement the new 2012 MPFS. These claims to be released into processing no later than January 18, 2012. Claims with dates of service prior to January 1, 2012, are unaffected. Finally, Medicare contractors will be posting the new rates on their websites no later than January 11, 2012.

New Screening codes for the year 2012

2012-01-08T09:54:00.002-05:00

G0442 Annual alcohol misuse screening, 15 minutes

G0443 Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes

G0444 Annual depression screening, 15 minutes

G0445 High intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes

G0446 Intensive behavioral therapy to reduce cardiovascular disease risk, individual, face-to-face, bi-annual, 15 minutes

G0447 Face-to-face behavioral counseling for obesity, 15 minutes

G0449 Annual face-to-face obesity screening, 15 minutes

G0450 Screening for sexually transmitted infections, includes laboratory tests for Chlamydia, Gonorrhea, Syphilis and Hepatitis B

G0451 Development testing, with interpretation and report, per standardized instrument form

Please see complete list of 2012 CPT code changes

2012 E Prescription

2012-01-08T09:39:00.002-05:00

With effect from Jan 1, 2012, the description for ERx G-code, G8553 has been revised to "Prescription(s) generated and transmitted via a qualiﬁed eRx system or a certiﬁed EHR system". Earlier it was 'At least one prescription created during the encounter was generated and transmitted electronically using a qualified eRx system'.

For successful reporting under the 2012 eRx Incentive Program, a single quality-data code (eRx G-code) should be reported, according to the following coding and reporting principles:

• Report the following eRx numerator G-code, when applicable:

G8553 - Prescription(s) generated and transmitted via a qualiﬁed eRx system or a certiﬁed EHR system (faxes do not count)

• The eRx G-code, which supplies the numerator, must be reported:

* on the claim(s) with the denominator billing code(s) that represent the eligible encounter for the 2012 eRx incentive payment; OR on the claim(s) with any billing code(s) that represent the encounter to avoid the 2013 eRx payment adjustment

* for the same beneficiary

* for the same date of service (DOS)

* by the same eligible professional (individual NPI) who performed the covered service as the payment codes, usually CPT Category I or HCPCS codes, which supply the denominator

Please note: For purposes of reporting the eRx G-code to avoid the 2013 eRx payment adjustment, the eRx G-code can be reported on the claim(s) during the reporting period, regardless of whether the code for such service appears in the denominator.

• The eRx G-code must be submitted with a line-item charge of zero dollars ($0.00) at the time the associated covered service is performed:

* The submitted charge field cannot be blank.

* The line-item charge should be $0.00.

* If a system does not allow a $0.00 line-item charge, a nominal amount, such as $0.01, can be substituted - the beneficiary is not liable for this nominal amount.

* Whether a $0.00 charge or a nominal amount is submitted to the Carrier/Medicare Administrative Contractor (MAC), the eRx G-code line is denied and tracked.

* ERx line items will be denied for payment, but are passed through the claims processing system to the National Claims History database (NCH) used for eRx claims analysis. Eligible professionals will receive a Remittance Advice (RA) which includes a standard remark code (N365). N365 reads: “This procedure code is not payable. It is for reporting/information purposes only.” The N365 remark code does NOT indicate whether the eRx G-code is accurate for that claim or for the measure the eligible professional is attempting to report. N365 only indicates that the eRx G-code passed into the NCH.

* If the entire claim is rejected, please review claim for errors before re-submitting. eRx G-codes will not be processed or tracked if the claim is rejected.

* When a group bills, the group National Provider Identifier (NPI) is submitted at the claim level, therefore, the individual rendering/performing physician’s NPI must be placed on each line item, including all allowed charges and quality-data line items.

* Solo practitioners should follow their normal billing practice of placing their individual NPI in the billing provider field (#33a on the CMS-1500 form or the electronic equivalent).

* Claims may NOT be resubmitted for the sole purpose of adding or correcting an eRx code.

CPT codes to report therapist services under Home Health Prospective Payment System (HH PPS)

2012-01-08T05:40:00.001-05:00

In order for CMS to collect more specific information regarding the sort of services provided to home health patients, we are revising the current descriptions for existing G-codes for physical therapists (G0151), occupational therapists (G0152), and speech-language pathologists (G0153), to include in the descriptions that they are intended for the reporting of services provided by a qualified physical or occupational therapist or speech language pathologist.

In addition CMS has added two new G-codes (G0157 and G0158) effective from the dates of services Jan 1, 2011 for the reporting of physical therapy and occupational therapy services provided by qualified therapy assistants.

• G0151 Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes.

• G0152 Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes.

• G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes.

• G0157 Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes.

• G0158 Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes.

In addition to the above CMS has also added three new G-codes for the reporting of the establishment or delivery of therapy maintenance programs by qualified therapists. The following are descriptions for those new G-codes, for the reporting of the establishment or delivery of therapy maintenance programs by therapists:

• G0159 Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, each 15 minutes.

• G0160 Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes.

• G0161 Services performed by a qualified speech-language pathologist, in the home health setting, in the establishment or delivery of a safe and effective speech-language pathology maintenance program, each 15 minutes.

Reference: https://www.cms.gov/transmittals/downloads/R824OTN.pdf

Payment for CPT 85025

2012-01-05T13:26:00.002-05:00

Data analysis and claim review findings by the Comprehensive Error Rate Testing (CERT) contractor has identified an increase in the number of errors related to incorrect billing of CPT 85025 and 85027. Providers are billing CPT 85025 when the documentation clearly supports billing of CPT 85027. CMS regulations state only services ordered by the physician should be performed and billed to Medicare.

CPT 85025 Complete Blood Count, with differential WBC, automated Consists of measuring a blood specimen for levels of hemoglobin (Hgb), hematocrit (Hct) , red blood cells (RBC), white blood cells (WBC), and platelets. Also, a differential white blood cell (WBC) count measures the percentages of different types of white blood cells.

CPT 85027 Complete Blood Count, automated Consists of measuring a blood specimen for levels of hemoglobin (Hgb), hematocrit (Hct) , red blood cells (RBC), white blood cells (WBC), and platelets.

If the coder is unsure of the intention of the physician he or she should query the physician. Always verify with physician prior to assigning the code if there is conflicting or incomplete information.

How to get paid for Prolia injection?

2012-01-04T13:47:00.006-05:00

Earlier Prolia injection was billed using HCPCS code either J3490 (Unclassified drugs) or J3590 (Unclassified biologics) but effective from January 1, 2012, a new HCPCS procedure code has been assigned to the drug denosumab (Prolia or Xgeva).

J0897 Injection, denosumab, 1 mg

The drug denosumab has two brand names with two different indications. The brand names and their indications are:

Prolia – Denosumab injection (Prolia) is used to treat osteoporosis (a condition in which the bones become thin and weak and break easily) in women who have undergone menopause and have an increased risk for fractures (broken bones) or who cannot take or did not respond to other medications for osteoporosis.

Xgeva – Denosumab injection (Xgeva) is used to reduce fractures from cancer that began in another part of the body but has spread to the bones. Denosumab injection (Xgeva) is not used to reduce fractures from multiple myeloma (cancer that begins in the plasma cells [a type of white blood cell that produces substances needed to fight infection]).

When billing the drug denosumab (Prolia) for patients with postmenopausal osteoporosis, the following ICD-9-CM code must be present on the claim:

733.01 - Senile osteoporosis

When billing the drug denosumab (Xgeva ) for patients with bone metastases from solid tumors, the following ICD-9-CM code must be present on the claim:

198.5 - Secondary malignant neoplasm of bone and bone marrow

Please also indicate in the comment section of the claim which drug is being administered, Prolia or Xgeva.

Please Note: When denosumab (Prolia or Xgeva ) is reported for Medicare payment using the recommend diagnosis code above, the medical record must clearly demonstrate the patient has, in fact, been so diagnosed. Utilizing the recommended diagnosis code in situations where medical records do not support the reported diagnosis is not appropriate.

Please also see the list of new J codes effective from Jan 1, 2012

Medicare MPPR (Multiple Procedure Payment Reduction)

2011-12-30T03:52:00.001-05:00

Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Imaging Procedures

Effective January 1, 2012 CMS is expanding the MPPR by applying it to PC services. Currently, the MPPR on diagnostic imaging services applies only the TC services. Full payment is made for each PC and TC service with the highest payment under the Medicare Physician Fee Schedule (MPFS). Payment is made at 75 percent for subsequent PC services furnished by the same physician to the same patient in the same session on the same day. Payment is made at 50 percent for subsequent TC services furnished by the same physician to the same patient in the same session on the same day. Due to operational considerations, CMS is not applying the imaging MPPR to group practices at this time.

The individual PC and TC services with the highest payments under the MPFS of globally billed services must be determined in order to calculate the reduction.When applying the reduction, Medicare contractors will use modifier 51 to identify reduced PC services and reduced global services as they do today for TC services. In addition, they will append Claim Adjustment Reason Code 59 (Processed based on multiple or concurrent procedure rules).

Please see the complete list of codes subject to the MPPR on diagnostic imaging

Reference:

http://www.cms.gov/MLNMattersArticles/downloads/MM7442.pdf

List of MPPR (Multiple Procedure Payment Reduction) codes

2011-12-30T03:48:00.001-05:00

The complete list of CPT codes subject to the MPPR on diagnostic imaging has been listed below.

"CPT copyright 2010 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association."

70336 Magnetic image jaw joint
70450 Ct head/brain w/o dye
70460 Ct head/brain w/dye
70470 Ct head/brain w/o & w/dye
70480 Ct orbit/ear/fossa w/o dye
70481 Ct orbit/ear/fossa w/dye
70482 Ct orbit/ear/fossa w/o&w/dye
70486 Ct maxillofacial w/o dye
70487 Ct maxillofacial w/dye
70488 Ct maxillofacial w/o & w/dye
70490 Ct soft tissue neck w/o dye
70491 Ct soft tissue neck w/dye
70492 Ct sft tsue nck w/o & w/dye
70496 Ct angiography head
70498 Ct angiography neck
70540 Mri orbit/face/neck w/o dye
70542 Mri orbit/face/neck w/dye
70543 Mri orbt/fac/nck w/o & w/dye
70544 Mr angiography head w/o dye
70545 Mr angiography head w/dye
70546 Mr angiograph head w/o&w/dye
70547 Mr angiography neck w/o dye
70548 Mr angiography neck w/dye
70549 Mr angiograph neck w/o&w/dye
70551 Mri brain w/o dye
70552 Mri brain w/dye
70553 Mri brain w/o & w/dye
70554 Fmri brain by tech
71250 Ct thorax w/o dye
71260 Ct thorax w/dye
71270 Ct thorax w/o & w/dye
71275 Ct angiography, chest
71550 Mri chest w/o dye
71551 Mri chest w/dye
71552 Mri chest w/o & w/ dye
71555 Mri angio chest w/ or w/o dye
72125 Ct neck spine w/o dye
72126 Ct neck spine w/dye
72127 Ct neck spine w/o & w/dye
72128 Ct chest spine w/o dye
72129 Ct chest spine w/dye
72130 Ct chest spine w/o & w/dye
72131 Ct lumbar spine w/o dye
72132 Ct lumbar spine w/dye
72133 Ct lumbar spine w/o & w/dye
72141 Mri neck spine w/o dye
72142 Mri neck spine w/dye
72146 Mri chest spine w/o dye
72147 Mri chest spine w/dye
72148 Mri lumbar spine w/o dye
72149 Mri lumbar spine w/dye
72156 Mri neck spine w/o & w/dye
72157 Mri chest spine w/o & w/dye
72158 Mri lumbar spine w/o & w/dye
72159 Mr angio spine w/o&w/dye
72191 Ct angiograph pelv w/o&w/dye
72192 Ct pelvis w/o dye
72193 Ct pelvis w/dye
72194 Ct pelvis w/o & w/dye
72195 Mri pelvis w/o dye
72196 Mri pelvis w/dye
72197 Mri pelvis w/o & w/dye
72198 Mr angio pelvis w/o & w/dye
73200 Ct upper extremity w/o dye
73201 Ct upper extremity w/dye
73202 Ct uppr extremity w/o&w/dye
73206 Ct angio upr extrm w/o&w/dye
73218 Mri upper extremity w/o dye
73219 Mri upper extremity w/dye
73220 Mri uppr extremity w/o&w/dye
73221 Mri joint upr extrem w/o dye
73222 Mri joint upr extrem w/dye
73223 Mri joint upr extr w/o&w/dye
73225 Mr angio upr extr w/o&w/dye
73700 Ct lower extremity w/o dye
73701 Ct lower extremity w/dye
73702 Ct lwr extremity w/o&w/dye
73706 Ct angio lwr extr w/o&w/dye
73718 Mri lower extremity w/o dye
73719 Mri lower extremity w/dye
73720 Mri lwr extremity w/o&w/dye
73721 Mri jnt of lwr extre w/o dye
73722 Mri joint of lwr extr w/dye
73723 Mri joint lwr extr w/o&w/dye
73725 Mr ang lwr ext w or w/o dye
74150 Ct abdomen w/o dye
74160 Ct abdomen w/dye
74170 Ct abdomen w/o & w/dye
74175 Ct angio abdom w/o & w/dye
74176 Ct abd & pelvis
74177 Ct abd & pelv w/contrast
74178 Ct abd & pelv 1/> regns
74181 Mri abdomen w/o dye
74182 Mri abdomen w/dye
74183 Mri abdomen w/o & w/dye
74185 Mri angio abdom w orw/o dye
74261 Ct colonography dx
74262 Ct colonography dx w/dye
75557 Cardiac mri for morph
75559 Cardiac mri w/stress img
75561 Cardiac mri for morph w/dye
75563 Card mri w/stress img & dye
75571 Ct hrt w/o dye w/ca test
75572 Ct hrt w/3d image
75573 Ct hrt w/3d image congen
75574 Ct angio hrt w/3d image
75635 Ct angio abdominal arteries
76604 Us exam chest
76700 Us exam abdom complete
76705 Echo exam of abdomen
76770 Us exam abdo back wall comp
76775 Us exam abdo back wall lim
76776 Us exam k transpl w/doppler
76831 Echo exam uterus
76856 Us exam pelvic complete
76857 Us exam pelvic limited
76870 Us exam scrotum
77058 Mri one breast
77059 Mri both breasts

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CPT Codes

2011-12-30T02:38:00.003-05:00

Newly added CPT codes

90869 Tcran magn stim redetemine
92071 Contact lens fitting for tx
92072 Fit contac lens for managmnt
92558 Evoked auditory test qual
92618 Ex for nonspeech dev rx add
93998 Noninvas vasc dx study proc
94726 Pulm funct tst plethysmograp
94727 Pulm function test by gas
94728 Pulm funct test oscillometry
94729 C02/membane diffuse capacity
94780 Car seat/bed test 60 min
94781 Car seat/bed test + 30 min
95885 Musc tst done w/nerv tst lim
95886 Musc test done w/n test comp
95887 Musc tst done w/n tst nonext
95938 Somatosensory testing
95939 C motor evoked upr&lwr limbs

Deleted CPT code list

90470 Immune admin H1N1 im/nasal
90663 Flu vacc pandemic H1N1
92070 Fitting of contact lens
92120 Tonography & eye evaluation
92130 Water provocation tonography
93720 Total body plethysmography
93721 Plethysmography tracing
93722 Plethysmography report
93875 Extracranial study
94240 Residual lung capacity
94260 Thoracic gas volume
94350 Lung nitrogen washout curve
94360 Measure airflow resistance
94370 Breath airway closing volume
94720 Monoxide diffusing capacity
94725 Membrane diffusion capacity

Please see complete list of 2012 CPT code changes

Nervous System 2012 CPT Updates

2011-12-26T12:16:00.004-05:00

New CPT codes

62369 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill

62370 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill (requiring physician’s skill)

64633 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint

64634 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint

64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint

64636 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint

Deleted CPT codes

64560 Percutaneous implantation of neurostimulator electrodes; autonomic nerve

64577 Incision for implantation of neurostimulator electrodes; autonomic nerve

64622 Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level

64623 Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level (List separately in addition to code for primary procedure)

64626 Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level

64627 Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, each additional level (List separately in addition to code for primary procedure)

Auditory System - Deleted CPT code

69802 Labyrinthotomy, with or without cryosurgery including other nonexcisional destructive procedures or perfusion of vestibuloactive drugs (single or multiple perfusions); with mastoidectomy

Also see complete list of 2012 CPT code changes

DIGESTIVE SYSTEM - 2012 CPT CODE CHANGES

2011-12-24T13:01:00.002-05:00

NEW CODES

49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance

49083 Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance

49084 Peritoneal lavage, including imaging guidance, when performed

DELETED CODES

49080 Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); initial

49081 Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); subsequent

Please see complete list of 2012 CPT code changes

2012 CPT code changes for Cardiology

2011-12-24T12:34:00.004-05:00

"CPT copyright 2010 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association."

Cardiovascular system - CPT updates for the year 2012

33221 Insertion of pacemaker pulse generator only; with existing multiple leads

33227 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system

33228 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system

33229 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; multiple lead system

33230 Insertion of pacing cardioverter-defibrillator pulse generator only; with existing dual leads

33231 Insertion of pacing cardioverter-defibrillator pulse generator only; with existing multiple leads

33262 Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator pulse generator; single lead system

33263 Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator pulse generator; dual lead system

33264 Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator pulse generator; multiple lead system

36251 Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral

36252 Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed;bilateral

36253 Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral

36254 Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; bilateral

37191 Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel, selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performd

37192 Repositioning of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed

37193 Retrieval (removal) of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed

37619 Ligation of inferior vena cava

Hemic and Lymphatic System

38232 Bone marrow harvesting for transplantation; autologous

Deleted CPT codes

35548 Bypass graft, with vein; aortoiliofemoral, unilateral

35549 Bypass graft, with vein; aortoiliofemoral, bilateral

35551 Bypass graft, with vein; aortofemoral-popliteal

35651 Bypass graft, with other than vein; aortofemoral-popliteal

37620 Interruption, partial or complete, of inferior vena cava by suture, ligation, plication, clip, extravascular, intravascular (umbrella device)

Please see complete list of 2012 CPT code changes

2012 CPT code updates for Respiratory System

2011-12-24T12:24:00.003-05:00

Newly added CPT code list

32096 Thoracotomy, with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incisional), unilateral

32097 Thoracotomy, with diagnostic biopsy(ies) of lung nodule(s) or mass(es) (eg, wedge, incisional), unilateral

32098 Thoracotomy, with biopsy(ies) of pleura

32505 Thoracotomy; with therapeutic wedge resection (eg, mass, nodule), initial

32506 Thoracotomy; with therapeutic wedge resection (eg, mass or nodule), each additional resection, ipsilateral (List separately in addition to code for primary procedure)

32507 Thoracotomy; with diagnostic wedge resection followed by anatomic lung resection (List separately in addition to code for primary procedure)

32607 Thoracoscopy; with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incisional), unilateral

32608 Thoracoscopy; with diagnostric biopsy(ies) of lung nodules(s) or mass(es) (eg, wedge, incisional), unilateral

32609 Thoracoscopy; with biopsy(ies) of pleura

32666 Thoracoscopy, surgical; with therapeutic wedge resection (eg, mass, nodule), initial unilateral

32667 Thoracoscopy, surgical; with therapeutic wedge resection (eg, mass or nodule), each additional resection, ipsilateral (List separately in addition to code for primary procedure)

32668 Thoracoscopy, surgical; with diagnostic wedge resection followed by anatomic lung resection (List separately in addition to code for primary procedure

32669 Thoracoscopy, surgical; with removal of a single lung segment (segmentectomy)

32670 Thoracoscopy, surgical; with removal of two lobes (bilobectomy)

32671 Thoracoscopy, surgical; with removal of lung (pneumonectomy)

32672 Thoracoscopy, surgical; with resection-plication for emphysematous lung (bullous or non-bullous) for lung volume reduction (LVRS), unilateral includes any pleural procedure, when performed

32673 Thoracoscopy, surgical; with resection of thymus, unilateral or bilateral

32674 Thoracoscopy, surgical; with mediastinal and regional lymphadenectomy (List separately in addition to code for primary procedure)

Deleted CPT codes

32095 Thoracotomy, limited, for biopsy of lung or pleura

32402 Biopsy, pleura; open

32500 Removal of lung, other than total pneumonectomy; wedge resection, single or multiple

32602 Thoracoscopy, diagnostic (separate procedure); lungs and pleural space, with biopsy

32603 Thoracoscopy, diagnostic (separate procedure); pericardial sac, without biopsy

32605 Thoracoscopy, diagnostic (separate procedure); mediastinal space, without biopsy

32657 Thoracoscopy, surgical; with wedge resection of lung, single or multiple

32660 Thoracoscopy, surgical; with total pericardiectomy

Please see complete list of 2012 CPT code changes

2012 CPT code changes - Musculoskeletal System

2011-12-24T12:17:00.002-05:00

New codes effective for the year 2012

20527 Injection, enzyme (eg, collagenase), palmar fascial cord (ie, Dupuytren’s contracture)

22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interpace (other than for decompression), single interspace and segment; lumbar

22634 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; each additional interspace and segment

26341 Manipulation, palmar fascial cord (ie, Dupuytren’s cord), post enzyme injection (eg, collagenase), single cord

29582 Application of multi-layer compression system thigh and leg, including ankle and foot, when performed

29583 Application of multi-layer compression system upper arm and forearm

29584 Application of multi-layer compression system upper arm, forearm, hand, and fingers

Deleted codes

No deleted codes in this category

Please see complete list of 2012 CPT code changes

What is PPMP (Provider-Performed Microscopy Procedures) ?

2011-12-24T10:05:00.002-05:00

Provider-performed microscopy (PPM) is a testing modality that requires the use of a microscope and is performed by a clinical practitioner during a patient encounter. A Certificate of Provider-Performed Microscopy Procedures (PPMP) permits a laboratory to perform a limited list of moderate complexity tests, as well as any waived tests. It is intended to be used in providers’ offices, outpatient clinics, public health clinics, health maintenance organizations, and medical training programs. Providers may include physicians, nurse practitioners,physicians’ assistants, or nurse midwives.

The following procedures are consisdered as Provider-Performed Microscopy Procedures (PPMP) and the performing laborotories should obtain a Certificate for Provider Performed Microscopy Procedures.

Q0111 - Wet mounts, including preparations of vaginal, cervical or skin specimens

Q0112 - All potassium hydroxide (KOH) preparations

Q0113 - Pinworm examinations

Q0114 - Fern test

Q0115 - Post-coital direct, qualitative examinations of vaginal or cervical mucous

81015 - Urinalysis; microscopic only

81000 - Urinalysis, by dipstick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy

81001 - Urinalysis, by dipstick or tablet reagent for bilirubin, glucose, hemoglobin,ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy (NOTE: May only be used when the lab is using an automated dipstick urinalysis instrument approved as waived.)

81020 - Urinalysis; two or three glass test

89055 - Fecal leukocyte examination

G0027 - Semen analysis; presence and/or motility of sperm excluding Huhner

89190 - Nasal smears for eosinophils

For more information please visit http://www.ndhealth.gov

Depression screening - Aetna medical coverage guidelines

2011-12-15T13:38:00.002-05:00

The Aetna Depression Management Program provides primary care physicians (PCPs) with a one-stop resource to help diagnose and treat Aetna patients with depression age 19 years and older.

This program promotes collaboration among PCPs, mental health professionals and Aetna’s care management team. Its focus is on proactive assessment and early intervention, with the goals of improving patients’ quality of life and treatment outcomes.

What the program offers

* A tool to screen for depression as well as monitor response to treatment

* Reimbursement for depression screening and follow-up monitoring

* Patient Health Questionnaire (PHQ-9) - specifically developed for use in primary care.

* Self-administered, quick and easy

* Specific for depression

* Available in English and Spanish

* Assistance with behavioral health referrals

* The option to refer eligible patients to Aetna’s Depression in Primary Care program by telephone

Billing requirements

CPT code: 99420 Administration and interpretation of a health risk assessment

ICD code: V79.0 (screening for depression)

To learn more, visit www.aetnadepressionmanagement.com

Also see Medicare coverage for Depression screening

Medicare coverage for Depression screening

2011-12-15T13:33:00.005-05:00

Effective October 14, 2011, Medicare covers annual screening for adults for depression in the primary care setting that has staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment, and follow-up

HCPCS code: G0444 - Annual depression screening, 15 minutes. (This code will appear on the January 2012 Medicare Physicians Fee Schedule update)

Type Of Service: 1

Place Of Service: G0444 would be covered only when services are provided at the following Places of Service (POS):

11 - Office
22 - Outpatient hospital
49 - Independent clinic
50 – FQHCs
71 - State or local public health clinic
72 – RHCs

Coverage Limitations

Coverage is limited to screening services and does not include treatment options for depression or any diseases, complications, or chronic conditions resulting from depression, nor does it address therapeutic interventions such as pharmacotherapy, combination therapy (counseling and medications), or other interventions for depression. Self-help materials, telephone calls, and web-based counseling are not separately reimbursable by Medicare and are not part of this NCD.

Screening for depression is non-covered when performed more than one time in a 12-month period. Eleven full months must elapse following the month in which the last annual depression screening took place. Medicare coinsurance and Part B deductible are waived for this preventive service.

Medicare will not pay G0444 separately with another encounter/visit on the same day billed on TOBs 71X or 77X. This does not apply, however, to claims with the Initial Preventive Physical Examination (IPPE) containing modifier 59 or to 77X claims containing Diabetes Self-Management Training or Medical Nutrition Training services.

Coinsurance and Deductibles

Effective October 14, 2011, beneficiary coinsurance and deductibles do not apply to claim lines with annual depression screening, G0444.

Also see Aetna coverage guidelines for Depression screening