Health Information Management

0016T now pays $260.24

APCs Insider, June 27, 2003

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June 27, 2003
Vol. 4, No. 25


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0016T now pays $260.24 and you can bill retroactive to January, 2003

CMS has changed the status indicator on 0016T (destruction of localized lesion of chloride transpupilary thermotherapy) to T, so it reimburses at $260.24.

The change is retroactive to January 1, 2003, so make sure you rebill any of these procedures performed since then.

Previously the code carried a status indicator of E, which indicates a non-covered item or service that "is not paid under Medicare or when performed in an outpatient setting."

PM A-03-051, issued June 13, changed the code's status and it now compacts to APC 0235 (Level I posterior segment eye procedures) with reimbursement.

To read the complete PM A-03-051, check out CMS Central on

Your APCs Weekly Monitor is a free weekly e-zine from HCPro, publisher of Briefings on APCs, the monthly newsletter devoted entirely to managing under APCs, and the newsletter, APC Answer Letter, with answers to readers' questions about coding for APCs.

The Monitor is a complimentary companion publication with a specific mission: to provide answers to your tough questions about the APC regulations.

If you have a question about APC coding that you would like addressed in the Monitor, post it on our Web site at Each week, our team of experts answers a question that will appeal to the majority of readers. The elected question and the corresponding answer are delivered to your inbox every Friday.

TODAY'S TOPIC: Billing code 94664

Question: In a recent Monitor, you advized that the description for code 94664,"Demonstration and or/evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing device," can only be reported one time per day.

The respiratory manager indicates that we have been unable to bill for patient teaching concerning these modalities because there was no code. Is this the intended use of this code given the technical description?

Answer: Yes, the CPT code recognizes the importance of patient instruction in this service. Furthermore, with the elimination of 94665, the limitation of 94664 to one per day, and the NCCI edit between 94640 and 94664, CMS is trying to channel hospitals to report the more comprehensive service.

CMS realizes that many procedures involve additional supportive services during the first adminsitration. Hospitals historically have compensated for this additional cost by either creating a first time/initial charge or a set-up charge.

In setting APC rates, CMS looked at historical claims and the resources required to administer a procedure. In some instances, it provided reimbursement differentials for the first and subsequent tests.

In your example, CMS took the additional resources for the first encounter and included them in the regular reimbursement.

ASK THE EXPERT: What has happened to the reimbursement for tetanus shots given in the ED? Both the drug and the administration code are packaged now. Did the tetanus vaccine somehow get mixed up with the hepatitis vaccine that will be reimbursed after June if you rebill it? Click here for the answer!

Coding and Compliance Feature Article of the Month: CMS clears up the foggy three-day payment window. Read more here.

PAY PER VIEW: Coding in real life: Will modifier -59 help? Briefings on APCs and Lolita M. Jones, RHIA, CCS, of Lolita M. Jones Consulting in Fort Washington, MD, bring you this month's coding quiz on the appropriate use of modifier -59 for two shoulder procedures.

Use the information provided to help solve this coding dilemma, and check your answer against the one provided by Jones.

Read more here.The cost is $10. Briefings on APCs subscribers have free access via their online subscriptions.

Questions from readers are answered by a team of experts working in the APC area within the health care industry. Their answers are provided as advice. Readers should consult the federal regulations governing OPPS, related CMS sources, and with their local fiscal intermediary before making any decisions regarding the application of OPPS to their particular situations.


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