Cardiac computed tomography (CCT) professionals will see major changes in coding next year. CPT® 2010 adds four new Category I codes to report CCT and cardiac computed tomography angiography (CCTA) services and deletes four Category III codes.

In a statement posted on its Web site prior to the Oct. 30 release of the 2010 Outpatient Prospective Payment System (OPPS) final rule, the Society of Cardiovascular Computed Tomography (SCCT) said it did not foresee significant changes in payment for CCT/CCTA. They were singing another tune Nov. 2.

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The Centers for Medicare & Medicaid Services (CMS) announced, Oct. 30, final changes to 2010 Medicare Physician Fee Schedule (MPFS) policies and payment rates. Taking into account all changes in the final rule, CMS projects a payment increase between 5 and 8 percent for health care professionals paid under the MPFS. That’s the good news …

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If, in fact, Medicare rates for physician services are inaccurate, how might the system be improved? The Medicare Payment Advisory Commission (MedPAC) met earlier this month to answer that very question. In November, the Centers for Medicare & Medicaid Services (CMS) will look at how relative values units (RVUs) are determined during a key process known as the five-year review, which will include a public comment period.

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According to the Centers for Medicare & Medicaid Services (CMS), billing staff often do not know where their physicians performed certain services, such as diagnostic test interpretations. Either that or they simply do not understand place of service (POS) codes enough to make informed decisions.

“The use of office or POS code 11 in certain situations has been problematic,” CMS says in a recent transmittal. Read more »

The 46 percent cut in single photon emission computed tomography (SPECT) reimbursement and 22 percent inrease in positron emission tomography (PET) reimbursement the Centers for Medicare & Medicaid Services (CMS) is proposing for 2010 has some speculating a significant rise in demand for cardiac PET in the coming years. Read more »

HCPCS Level II code Q2024 Bevacizumab injection will be reimbursed by Medicare effective October 1. Distributed under the trade name Avastin, the drug inhibits angiogenesis — the uncontrolled spread of blood vessels feeding cancer tumors and diabetic retinal proliferation in the eye.

To help you code this drug, which is often administered in concert with a chemotherapeutic drug, the code’s status indicator is “E,” which means Bevacizumab is excluded from the Medicare Physician Fee Schedule Data Base (MPFSDB) by regulation and has no relative value listed, but is paid under reasonable charge procedures. Type of service (TOS) codes are “1″ (Medical Care) and “P” (lump sum purchase of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies or DMEPOS).

Read the Centers for Medicare & Medicaid Services (CMS) Transmittal 1805 to learn more.

In the last EdgeBlast issue, we reported that HCPCS Level II codes for the H1N1 vaccine and Bevacizumab injection were recently added to the Medicare Physician Fee Schedule Database (MPFSDB), but you should also note other important changes this year’s October update holds in store. Read more »

A new proposal from the Centers for Medicare & Medicaid Services (CMS) to cut payments for radiation therapy treatments would cause many cancer centers to close, stop accepting Medicare patients, lay off support staff, and reduce services to cancer patients, according to a survey conducted by the American Society for Radiation Oncology (ASTRO).

On July 13, CMS announced in the Medicare Physician Fee Schedule (MPFS) proposed rule for 2010 proposed changes to Medicare policies and payment rates for physician services, including radiation oncology, that would cut payments to radiation therapy services by nearly 20 percent. Read more »

A minor software problem resulted in the non-transmittal of some public comments on two proposed rules submitted between July 26-30 via www.regulations.gov.

The problem has been corrected and the Centers for Medicare & Medicaid Services (CMS) is requesting the public resubmit their comments on the 2010 Physician Fee Schedule or 2010 Hospital Outpatient Prospective Payment System/Ambulatory Surgical Center Payment System proposed rule before the close of the comment period for these rules (Aug. 31, 2009).

Click here for information on how to resubmit public comment on either of these two proposed rules.

Ambulance suppliers soon will be required to report mileage to the nearest tenth of a mile for all Medicare claims totaling up to, but not including, 100 covered miles.

Presently, ambulance suppliers round the mileage up to the nearest whole mile for trips totaling less than a whole number mile. This was necessary because the Medicare fee-for-service claims processing system was unable to accept fractional units of mileage on ambulance claims.

As the system is now able to process mileage HCPCS Level II codes to a tenth of a mile, suppliers should submit fractional mileage using a decimal in the appropriate place (e.g. 99.9) effective Jan. 1, 2010. For mileage totaling less than 1 mile, include a zero before the decimal point (e.g. 0.9). For trips totaling 100 or more covered miles, suppliers should continue to report mileage rounded to the nearest whole number.

This policy applies only to ambulance services billed on CMS-1500 paper claims or ANSI X12N 837P electronic claims. This policy does not apply to hospital-based ambulance services.

For further details, see the Centers for Medicare & Medicaid Services (CMS) Transmittal 1787, issued July 31.