Nine medical specialty societies questioned and have identified field-specific tests or procedures that they say are commonly ordered, but usually unnecessary. Their aim is to decrease health care overuse and misuse.

The organizations represent nearly 375,000 physicians and are part of Choosing Wisely, an initiative led by the American Board of Internal Medicine (ABIM) Foundation and Consumer Reports. The nine societies include:

• American Academy of Allergy, Asthma & Immunology
• American Academy of Family Physicians
• American College of Cardiology
• American College of Physicians
• American College of Radiology
• American Gastroenterological Association
• American Society of Clinical Oncology
• American Society of Nephrology
• American Society of Nuclear Cardiology

According to ABIM Foundation News, “U.S. Physician Groups Identify Commonly Used Tests or Procedures They Say Are Often Not Necessary,” the societies questioned these common practices for patient care:

• Do patients need brain imaging scans like a computed tomography (CT) or magnetic resonance imaging (MRI) after fainting, also known as simple syncope? (American College of Physicians)
• Do otherwise healthy adults need stress imaging tests for annual checkups? (American College of Cardiology)
• Should patients going into outpatient surgery receive a chest X-ray beforehand? (American College of Radiology)
• Do patients need a CT scan or antibiotics for chronic sinusitis? (American Academy of Allergy, Asthma & Immunology)
• Should dialysis patients who have limited life expectancies and no signs or symptoms of cancer get routine cancer screening tests? (American Society of Nephrology)
• Should women under 65 or men under 70 be screened for osteoporosis with dual energy X-ray absorptiometry (DEXA)? (American Academy of Family Physicians)

There are more societies emerging in the Choose Wisely campaign. The new societies are scheduled to release their list of unnecessary and misused test or procedures in the fall.

The spreadsheet containing HCPCS Level II codes for durable medical equipment Medicare administrative contractor (DME MAC), Part B carrier, or A/B MAC jurisdictions has been updated for 2012 to reflect supply codes that have been added or discontinued.

As part of the 2012 update, the following HCPCS Level II codes are affected:

L8511 Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each
L8512 Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10
L8513 Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each
L8514 Tracheoesophageal puncture dilator, replacement only, each
L8515 Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each

These voice prosthesis codes are changing claims processing jurisdiction from DME MAC to joint local carrier and DME MAC jurisdiction if used with tracheoesophageal voice prostheses inserted by a licensed health care provider. Otherwise, continue to submit claims for these codes to the appropriate DME MAC.

Carriers and A/B MACs will manually price claims for these codes with dates of service on or after Jan. 1, 2012 using the 2012 durable medical equipment prosthetics, orthotics, and supplies (DMEPOS) fee schedule, found in Attachment B of Change Request (CR) 7679.

Billing staffs should refer to this spreadsheet to ensure the appropriate Medicare contractor is being billed for HCPCS Level II codes that appear in the list.

Source: MLN Matters® article MM7679, issued March 23, 2012

The latest National Correct Coding Initiative (NCCI) edits, Version 18.2, is effective July 1 and available through the Centers for Medicare & Medicaid Services (CMS) Data Center. The Recurring Update Notification applies to Medicare Claims Processing Manual, chapter 23, section 20.9. You can look forward to the release of a test file around May 2. A final file will be available around May 17.

Version 18.2 includes previous versions and updates from Jan. 1, 1996 to now, and is organized in two tables:

• Column 1/Column 2 Correct Coding Edits
• Mutually Exclusive Code (MEC) Edits

The coding policies are based on coding conventions defined in the:

• American Medical Association’s (AMA’s) CPT® manual
• National and local policies and edits
• Coding guidelines developed by national societies
• Analysis of standard medical and surgical practice
• Review of current coding practice

See MLN Matters® article MM7802 for more information. EdgeBlast or Coding Edge will keep you abreast on the updates when the final document is released.

Certified facilities performing laboratory tests should be aware of a recent update to the list of codes subject to or excluded from Clinical Laboratory Improvement Amendments (CLIA) edits.

New codes subject to CLIA edits and payable under Medicare are shown in the table below.

CPT® 2012 added 101 new codes for molecular pathology (81200-81408) that are subject to CLIA edits; however, these codes are not payable under Medicare.

Effective Jan. 1, 2012, CPT® codes 88107 Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears and filter preparation with interpretation and 88318 Determinative histochemistry to identify chemical components (e.g., copper, zinc) have been discontinued. (To report smears and simple filter preparation, see 88104 Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation or 88106 Cytopathology, fluids, washings or brushings, except cervical or vaginal; simple filter method with interpretation. For determinative histochemistry to identify chemical components, use 88313 Group II, all other (e.g., iron, trichrome), except stain for microorganisms, stains for enzyme constituents, or immunocytochemistry and immunoperoxidase.)

The Centers for Medicare & Medicaid Services (CMS) notified contractors of these changes on April 6, in Transmittal 2441. Contractors are to implement these changes by July 2, 2012. Contractors are not required to search their files to either retract or pay claims already submitted, but are instructed by CMS to adjust claims brought to their attention.

For more information, see CMS Transmittal 2439 and MLN Matters® articles MM7795, MM7766.

The Centers for Medicare & Medicaid Services (CMS) has instructed fiscal intermediaries (FIs) and Medicare administrative contractors (MACs) to hold claims for the device described by HCPCS Level II code C1882 Cardioverter-defibrillator, other than single or dual chamber (implantable) when reported with the procedure described by CPT^® code 33249 Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber.

Only Medicare claims containing both C1882 and 33249 with dates of service between Jan. 1, 2012 and June 30, 2012 are affected.

CMS recently discovered that the procedure-to-device edit files included in the January 2012 (V13.0) and April 2012 (V13.1) Integrated Outpatient Code Editor (I/OCE) do not allow C1882 to satisfy the edit in place for 33249.

According to CMS, the July 2012 I/OCE (V13.2) will be updated with a new procedure-to-device edit file that will allow HCPCS Level II code C1882 to be billed with CPT^® code 33249, and carriers will begin processing held claims beginning July 2, 2012.