Q/A: New composites for 2012
APCs Insider, February 17, 2012
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Q:What new composites, if any, did CMS create for 2012?
A: CMS created a new composite for cardiac resynchronization therapy. The new composite affects CPT® codes:
- 33249 (Insertion or repositioning of electrode lead[s] for single or dual chamber pacing cardioverter-defibrillator and insertion of pulse generator )
- 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 coders report these codes on one claim for the same date of service, CMS will process the claim as a composite service and make a single payment. When coders report these codes on different dates of service or only report one code of the pair, CMS will make a payment for the individual APC assignment for each code.
CMS assigned status indicator Q3 to both codes to indicate they may be part of a composite methodology. Based oninformation submitted on a UB-04, the Integrated Outpatient Code Editor will apply composite guidelines and determine payment accordingly.
In a related matter, CMS implemented a claims processing edit to ensure that CPT code 33225 is billed with one of the procedure codes for implantation of a cardioverter-defibrillator or pacemaker. See the parenthetical note after the code in the CPT Manual for a listing of codes. CMS has added §10.2.2 to Chapter 4 of the Medicare Claims Processing Manual to reflect the new composite and claims processing edits for CPT code 33225. Refer to Transmittal 2386 for additional information.
Editor’s note: Andrea Clark, RHIA, CCS, CPCH, chairman, CEO, and founder of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.
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