Health Information Management

Healthcare News: CMS releases national coverage determinations

JustCoding News: Outpatient, August 22, 2012

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CMS recently released two new national coverage determinations (NCD).

CMS will now cover transcatheter aortic valve replacement (TAVR) under its Coverage with Evidence Determination criteria. Physicians use TAVR to treat aortic stenosis by inserting a bioprosthetic valve percutaneously using a catheter and implanting the valve in the orifice of the aortic valve.
 
For TAVR services furnished on or after May 1, 2012, coders should report the appropriate temporary level III CPT® code:
  • 0256T, Implantation of catheter-delivered prosthetic aortic heart valve; endovascular approach
  • 0257T, Implantation of catheter-delivered prosthetic aortic heart valve; open thoracic approach (e.g., transapical, transventricular)
  • 0258T, Transthoracic cardiac exposure (i.e. sternotomy, thoracotomy, subxiphoid) for catheter-delivered aortic valve replacement; without cardiopulmonary bypass
  • 0259T, Transthoracic cardiac exposure (i.e. sternotomy, thoracotomy, subxiphoid) for catheter-delivered aortic valve replacement; with cardiopulmonary bypass
For a complete list of the conditions of coverage for TVAR, review the NCD and MLN Matters article 7897.
CMS will now cover the use of transcutaneous electrical nerve stimulation (TENS) for chronic low back pain NCD 160.27) in specific situations.
 
For this NCD, Medicare defines chronic low back pain as pain for more than three months and not a manifestation of a clearly defined and generally recognizable primary disease entity. In addition, the patient must enroll in an approved clinical study under coverage with evidence development.
 
The TENS is a type of electrical nerve stimulator used to treat chronic intractable pain. This stimulator is attached to the surface of the patient’s skin over the peripheral nerve to be stimulated. Providers use TENS in various settings, including the patient’s home, a physician’s office, or in an outpatient clinic.
 
For more information, review the NCD and MLN Matters article 7836.



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