Health Information Management

Q&A: STVX and T-packaged codes

APCs Insider, April 11, 2008

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QUESTION:  In Addendum B, CPT code 49465, Contrast injections(s) for radiological evaluation of existing gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, from a percutaneous approach including image documentation and report, has a status indicator of “Q” (i.e., conditionally packaged). However, it is not listed in Table 10 of the OPPS final rule as either a status indicator STVX, or T packaged code. Under what conditions is this code packaged? Where can I find more information on this code?
ANSWER: In the Hospital Outpatient Regulations and Notices section of the CMS Web site, you can find an Excel file titled STVX and T Packaged Codes. You can find it on the page for the calendar year (CY) 2008 final rule. In that file, CMS lists CPT code 49465 as an STVX packaged code, meaning that it is packaged with any S, T, V, or X status indicator item or service on the same claim. However, CMS will pay separately for this code when there are no services with these status indicators on the same claim. 
Table 10 of the final rule identifies codes that were assigned to the packaging categories for CY 2008. Additionally, the codes that CMS considered "special packaged codes" (a concept from CY 2007 that is very similar to STVX packaging concept) were also designated STVX packaged for CY 2008. However, being a new code for 2008, CPT code 49465 was not listed as a "special packaged code" for CY 2007. It is unclear how CMS designated CPT code 49465 as an STVX packaged code.
Note that there is one other code that is also not listed in Table 10, and it was not a “special packaged code” for CY 2007. New CPT code 36591 was also designated as an STVX packaged code in the Excel file, presumably because it replaced one of the special packaged codes from CY 2007. But that is not the case with CPT code 49465. Therefore, it remains unclear as to how CMS arrived at the designation of STVX packaged for this code.

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