Health Information Management

Q/A: New composites for 2012

APCs Insider, February 17, 2012

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

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.

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Most Popular