Health Information Management

July I/OCE updates: CMS reinstates device-to-procedure edit, adds new codes

JustCoding News: Outpatient, August 8, 2012

Want to receive articles like this one in your inbox? Subscribe to JustCoding News: Outpatient!

HCPCS code C1882 (cardioverter-defibrillator, other than single or dual chamber [implantable]) will once again meet the criteria to override the device-to-procedure edit for CPT® code 33249 (insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead[s], single or dual chamber).

CMS instituted two types of edits for procedures requiring devices: the device-to-procedure edits and the procedure-to-device edits. In a nutshell, the claim must include codes for both the procedure and the device, says Dave Fee, MBA, product marketing manager of outpatient products at 3M Health Information Systems in Murray, Utah.

In the April update to the I/OCE, CMS removed C1882 from the list of acceptable devices for CPT code 33249. In the July update, CMS reinstated code C1882 to the approved device list and made the change retroactive to January 1.
 

Deleted NCCI edits
CMS invalidated NCCI edits 19 and 39, retroactive to the beginning of OPPS. This is because the ­mutually ­exclusive code pair table is now combined with the code 1/code 2 table. “If someone processed a historical claim before the July update that had an edit 19 or 39, and now reprocesses it, edit 20 or 40 will surface instead,” Fee says.
 
New HCPCS codes
CMS added the following six HCPCS codes to the I/OCE effective July 1:
  • Q2045, injection, human fibrinogen concentrate, 1 mg
  • Q2046, injection, aflibercept, 1 mg
  • Q2047, injection, Peginesatide, 0.1 mg (for ESRD on dialysis)
  • Q2048, injection, doxorubicin hydrochloride, ­liposomal, doxil, 10 mg
  • Q2049, injection, doxorubicin hydrochloride, ­liposomal, imported lipodox, 10 mg
  • Q2034, influenza virus vaccine, split virus, for ­intramuscular use (Agriflu)

Three of the codes replace current HCPCS Level II codes. Code Q2045 will replace code J1680 (injection, human fibrinogen concentrate, 100 mg) July 1. Code Q2046 will replace C9291 (injection, aflibercept, 2 mg vial), and code Q2048 will replace J9001 (injection, doxorubicin hydrochloride, all lipid formulations, 10 mg).

Codes Q2045, Q2048, and Q2049 all have status indicator K (paid under OPPS; separate APC payment). Code Q2046 is assigned status indicator G (pass-through drugs and biologicals). Code Q2047 has status indicator A (services furnished to a hospital outpatient that are paid under a fee schedule or payment system other than OPPS). Code Q2034 falls under status indicator L (influenza vaccine; pneumococcal pneumonia vaccine).

In addition, CMS added the following HCPCS codes effective April 1:
  • G8907, patient documented not to have experienced any of the following events: a burn prior to discharge, a fall within the facility, wrong site/side/patient/­procedure/implant event, or a hospital transfer or ­hospital admission upon discharge from the facility
  • G8908, patient documented to have received a burn prior to discharge
  • G8909, patient documented not to have received a burn prior to discharge
  • G8910, patient documented to have experienced a fall within ASC
  • G8911, patient documented not to have experienced a fall within ASC
  • G8912, patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event
  • G8913, patient documented not to have experienced a wrong site, wrong side, wrong patient, wrong ­procedure or wrong implant event
  • G8914, patient documented to have experienced a hospital transfer or hospital admission upon ­discharge from ASC
  • G8915, patient documented not to have ­experienced a hospital transfer or hospital admission upon ­discharge from ASC
  • G8916, patient with preoperative order for IV anti­biotic surgical site infection (SSI) prophylaxis, ­anti­biotic initiated on time
  • G8917, patient with preoperative order for IV anti­biotic surgical site infection (SSI) prophylaxis, ­anti­biotic not initiated on time
  • G8918, patient without preoperative order for IV anti­biotic surgical site infection (SSI) prophylaxis
 
These codes have a status indicator M (items and services not billable to the FI) and trigger I/OCE edit 72 (service not billable to the FI/MAC).
 
New CPT Category III codes
CMS added seven Category III CPT codes to the I/OCE. The AMA released the new codes in January for implementation in July. The codes are:
  • 0302T–0304T, insertion or removal and replacement of intracardiac ischemia monitoring system
  • 0305T, programming device evaluation (in person) of intracardiac ischemia monitoring system with iterative adjustment of programmed values, with analysis, review, and report
  • 0306T, interrogation device evaluation (in person) of intracardiac ischemia monitoring system with analysis, review, and report
  • 0307T, removal of intracardiac ischemia monitoring device
  • 0308T, insertion of ocular telescope prosthesis including removal of crystalline lens

Codes 0302T–0304T and 0307T–0308T have status indicator T (significant procedure, multiple reduction applies). Codes 0305T and 0306T have status indicator S (significant procedure, not discounted when multiple).

Code 0308T replaces code C9732 (insertion of ­ocular telescope prosthesis including removal of ­crystalline lens).

Device pass-through category C1840 must be billed with CPT code 0308T to receive pass-through payment. CMS assigned CPT code 0308T to APC 0234 (Level IV anterior segment eye procedures), so the device offset will not change.
 
New pass-through drugs
CMS granted pass-through status to C9368 (Grafix core, per square centimeter) and C9369 (Grafix prime, per square centimeter).
 
Status indicator changes
CMS reassigned the following eight codes to status indicator K (paid under OPPS; separate APC payment):
  • 90581, anthrax vaccine, for subcutaneous or intramuscular use
  • J2265, injection, minocycline hydrochloride, 1 mg
  • J8650, nabilone, oral, 1 mg
  • Q0174, thiethylperazine maleate, 10 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
  • Q4123, Alloskin RT, per square centimeter
  • Q4125, Arthroflex, per square centimeter
  • Q4128, FlexHD or Allopatch HD, per square centimeter
  • Q4129, Unite Biomatrix, per square centimeter
 
All eight codes previously fell under status indicator E (not paid by Medicare when submitted on outpatient claims [any outpatient bill type]).
 
Inherently bilateral code
CMS added CPT code 92072 (fitting of a contact lens for management of keratoconus, initial fitting) to the list of inherently bilateral codes, meaning it is now improper to use a modifier with it, Fee says.
 
 
Editor’s note: This article was originally published in the August issue of Briefings on APCs. Email your questions to Senior Managing Editor Michelle A. Leppert, CPC, at mleppert@hcpro.com.

 



Want to receive articles like this one in your inbox? Subscribe to JustCoding News: Outpatient!

Most Popular