Health Information Management

CMS update: HCPCS Level II codes for services added to New Technology APCs

APCs Insider, April 16, 2004

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QUESTION: Is it true that Medicare will release HCPCS Level II codes for services added to New Technology APCs? How often will that occur?

ANSWER: Medicare will post updates to Addendums A and B on a quarterly basis, beginning April 1, then following July 1 and October 1. In addition, quarterly updates of the final January 1 OPPS rules will be provided starting with Transmittal 132 Publication 100-04. Within this document the following codes are effective April 1, 2004:

  • C9712, insertion of a pH capsule for measurement and monitoring of gastroesophaeal reflux disease (GERD), includes data collection and interpretation. If a single endoscopy is used to place the capsule, the endoscopy can be coded separately and only once. The first catheter-free system used to measure esophageal pH (acidity) levels in patients who have or are suspected of having GERD is the BravoT pH Monitoring System from Medtronic. This procedure links to APC 1560, status indicator S, with a national unadjusted payment rate of $450.
  • C9713, non-contact laser vaporization of prostate, including coagulation control of intraoperative and post-operative bleeding. It is important that coders do not confuse this code with 52647, which states "non-contact coagulation." This code was developed for the purposes of a new treatment for enlarged prostate, i.e., GreenLight Photoselective Vaporization of the prostate (PVPT), pioneered by Laserscope. This links to APC 1525, status indicator S, with a national unadjusted payment rate of $3,750.
  • C9714, placement of balloon catheter into the breast for interstitial radiation therapy following partial mastectomy; concurrent/immediate (add-on).
  • C9715, placement of balloon catheter into the breast for interstitial radiation therapy following partial mastectomy; delayed.

The MammoSiteT device is a balloon catheter inserted directly into the space created when a tumor is removed during a lumpectomy. During therapy, a tiny radioactive seed attached to a wire is inserted into the balloon, delivering radiation to the tissues surrounding the space that was recently home to a tumor. Alternatively, patients can wait until up to 10 weeks after surgery to have the device inserted. C9714 links to APC 1523, status indicator S, with a national unadjusted payment rate of $2,750. C9715 links to APC 1524, status indicator S with a national unadjusted payment of rate $3,250.

For further information, go to http://www.cms.hhs.gov/manuals/pm_trans/R132CP.pdf.



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