Archive for the ‘ICD-9-CM’ Category

The Centers for Medicare & Medicaid Services (CMS) has made a few important changes to the National Coverage Determination (NCD) edit software for clinical diagnostic laboratory services worth noting. In particular, a change to the effective date of coverage for three NCD ICD-9-CM diagnosis code lists will allow clinics to recoup any lost payments due to erroneous denials.

The effective date for three NCDs was “inadvertently” changed from Oct. 1, 2007 to July 1, 2009 with the July 1 quarterly release. The January 2010 quarterly release of the edit module for clinical diagnostic laboratory services corrects this mistake.

The affected ICD-9 code lists are those in the following NCDs:

• Prothrombin Time (PT) (190.17)
• Serum Iron Studies (190.18)
• Gamma Glutamyl Transferase (190.32)

The effective date for the ICD-9 codes listed in these NCDs will be revised from July 1, 2009 to Oct. 1, 2007, effective Jan. 1, 2010.

The January 2010 quarterly update also relocates ICD-9 codes 453-50 – 453.52 from the Serum Iron Studies NCD to the Gamma Glutamyl Transferase NCD, effective Jan. 1, 2010.

Medicare instructs contractors in Transmittal 1847, issued Nov. 6, not to search their files to retroactively pay claims but to adjust claims brought to their attention. A provider education article is available on the CMS Web site, and includes a list of affected ICD-9 codes.

End-stage renal disease (ESRD) facilities concerned about a proposed ESRD prospective payment system (PPS) that would replace the current payment system and methodologies still have time to stand up and be heard. The Centers for Medicare & Medicaid Services (CMS) has extended the comment period out by 30 days.

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The Food and Drug Administration (FDA) approved the first fully-robotic surgery device, the da Vinci® surgical system, in early 2000. In recent years, robotic surgery—technically called laparoscopic robotic-assisted surgery—has revolutionized minimally invasive surgery (MIS).

Robotic-assistance has been adopted by several surgical specialties for complex procedures, such as mitral valve repair, Roux-en-Y, prostectomy, hysterectomy, sacral colpopexies, coronary anastomosis, nephrectomy, and others.

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Health care providers in Colorado, New Mexico, Oklahoma and Texas submitting claims to TrailBlazer Health Enterprises should be aware of revisions the jurisdiction 4 (J4) Part A and Part B Medicare Administrative Contractor (A/B MAC) made, Oct. 5, to two local coverage determinations (LCD).

The revisions were made in response to a recent addition to the list of HCPCS Level II codes payable by Medicare, as noted in the October 2009 quarterly update released Aug. 28 by the Centers for Medicare & Medicaid Services (CMS). Read more »

A recent update to the ICD-9-CM Official Guidelines for Coding and Reporting gives coders a choice of diagnosis codes to differentiate between the two types of influenza virus patients may present with this year. Read more »

The Centers for Medicare & Medicaid Services (CMS) issued, Oct. 7, a correction document to the 2010 Inpatient Prospective Payment System (IPPS) for acute care hospitals and Long Term Care Hospital Prospective Payment System (LTCH PPS) final rule. Make hospital billing staff aware of these corrections, which include changes to important compliance dates and payment rates. Read more »

Submitted by Marlene Doty, CPC, CUC, PCS

A physician may offer a male patient diagnosed with low testosterone, or “Low T,” varying options of medical treatment to relieve symptoms. One of those options is testosterone replacement therapy, which consists of testosterone pellets inserted by subcutaneous implantation once every 3-6 months in the office. Before billing for this procedure, however, it is important to contact the specific insurance carrier for coverage determination and, if required, prior authorization.

Low testosterone is the body’s inability to produce enough testosterone. Symptoms of low testosterone may include: loss of energy and moodiness, diminished sex drive, weight gain, and loss of muscle mass and bone strength.

Generally, you will report CPT® 11980 Subcutaneous hormonal pellet implantation beneath the skin, along with either HCPCS Level II code S0189 testosterone pellet, 75 mg or J3490 unclassified drug (depending on the Medicare carrier’s requirements).

Remember: Code J3490 is to be used only when a distinct HCPCS Level II code for the drug being administered has not been released. Whenever J3490 is used, you must include the name of the drug and any pertinent information, such as dosage and route of administration. Medicare policy is based on 106 percent of the Wholesale Acquisition Cost (WAC), or invoice pricing if the WAC is not published. Be prepared to furnish copies of invoices upon request.

Dosage is the total number of pellets implanted. The manufacturer’s 11-digit NDC number is placed on line 19 of the CMS-1500 form.

Diagnosis codes most commonly used are 257.2 other testicular hypofunction, 257.8 other testicular dysfunction, or 257.9 unspecified testicular dysfunction.

Recent changes to Pub. 100-03 of the Medicare National Coverage Determinations (NCD) Manual may soon affect the way your practice bills for f-18 flouro-D-glucose positron emission tomography (FDG PET) imaging services. Read more »

Having trouble getting paid for genioglossos advancement? The American Academy of Otolaryngology — Head and Neck Surgery and your state otolaryngology society may be of assistance.

The AAO-HNS recently sent letters to Wisconsin Physician Services (WPS) and Anthem Blue Cross regarding their coverage policies for mandibular segmental osteotomy with genioglossus advancement (21199, Osteotomy, mandible, segmental; with genioglossus advancement) when performed to treat obstructive sleep apnea (OSA).

“We wrote a letter (to WPS) indicating that it should be covered, and, as a result of the information we provided, they decided to cover it on a case-by-case basis,” says Udo Kaja, AAO-HNS’s health policy program manager.

After confirming whether your payer will reimburse 21199, check your diagnosis code selection, advises Otolaryngology Coding Alert. CPT® code “21199 treats OSA (327.23 Organic sleep apnea; obstructive sleep apnea [adult] [pediatric]) and not any of several other sleep disorders, such as central sleep apnea (327.21, Primary central sleep apnea), where the brain forgets to breathe but there are no physical obstructions,” writes the medical coding newsletter.

Tip: Make sure 327.23 has been confirmed with a sleep study.

Read more about OSA and new policy requirements for sleep studies on the Coding News Web site.