Health Information Management

CMS announces changes to two CPT codes

APCs Insider, December 13, 2013

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CMS recently announced a pair of CPT® code changes, including the replacement of a Category III HCPCS code, effective January 1, 2014. CMS announced the changes in Transmittal 2827.

Category III HCPCS code 0318T (transcatheter aortic valve replacement [TAVR/TAVI] with prosthetic valve; transapical approach) will be replaced with CPT code 33366 for dates of service on or after January 1, 2014.

Physicians use transcatheter aortic valve replacement (TAVR, also known as transcatheter aortic valve implantation or TAVI) to treat aortic stenosis. An interventional cardiologist and cardiac surgeon jointly participate in the intra-operative technical aspects of TAVR.

Transmittal 2827 updates Transmittal 2628 from January 7, 2013. Transmittal 2628 implemented replacement codes for TAVR claims with dates of service on and after January 1, 2013, and contains more detailed billing instructions for TAVR services.

Providers should also note that if a TAVR claim is denied because a place of service (POS) code other than POS code 21 was used, the following messages will also be used:

• Claim Adjustment Reason Code (CARC) 58: “Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.”

CMS also recently published Transmittal 2824, which provides instructions for updating payment and Common Working File edits to include influenza virus vaccine CPTcode 90673 (influenza virus vaccine, trivalent, derived from recombinant DNA [RIV3], hemagglutinin protein only, preservative and antibiotic free, for intramuscular use), for claims with dates of service on or after January 1, 2014, that are processed on or after April 1, 2014.

Transmittal 2824 also corrects the effective date of HCPCS code Q2033 (influenza vaccine, recombinant hemagglutinin antigens, for intramuscular use [Flublok]) from January 1, 2013, to July 1, 2013.

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