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Tag Archives: includes

OPPS Rule for 2019 Includes Curbing Utilization

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Utilization, new codes, device pass-through, and 340B payment policies top the changes in the Centers for Medicare & Medicaid Services’ (CMS) Outpatient Prospective Payment System (OPPS) final rule for 2019. Cutting OPPS Costs CMS said in a fact sheet with the long-winded title of “CMS finalizes Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical […]

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ICD-11 Includes New Sections, Benefits

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As we all just implemented ICD-10 changes for 2019, I thought I would let you know that ICD-11 is being worked on. Don’t worry, it is not going to be implemented next year, but it is being planned for some time after 2022, which is actually not very far away. We will have just gotten […]

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April Update Includes Biosimilar Biologicals Code Changes

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Effective Jan. 1, 2018, newly approved biosimilar biologicals with a common reference product are no longer grouped into the same billing code. This change was finalized in the 2018 Medicare Physician Fee Schedule final rule. Q5102 Replaced with Two New Codes The April 2018 update to the Medicare Physician Fee Schedule Database (MPFSD) includes three […]
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House Bill Includes Telehealth, Meaningful Use

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As Congress bar brawls over the next spending bill, the House of Representative’s version as a nod to telehealth and meaningful use, includes the “Creating High-quality Results and Outcomes Necessary to Improve the CHRONIC Care Act of 2017”, legislation to ease the “meaningful use burden on providers and reduce the volume of electronic health record-relating […]
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NCCI Manual includes clarifications for modifier -59 usage, injections and infusions

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By Steven Andrews
With the latest edition of the NCCI Manual, effective January 1, CMS does not introduce any new guidance for recurring coding trouble areas including modifier -59 (distinct procedural service) usage and injection and infusion services, but some new clarifications could aid coding departments.
 
The manual now includes new information regarding modifier -59 use for procedures performed at the same patient encounter. The expanded example for timed services, with 2016 additions bolded, now says:
There is an appropriate use for modifier -59 that is applicable only to codes for which the unit of service is a measure of time (e.g., per 15 minutes, per hour). If two separate and distinct timed services are provided in separate and distinct time blocks, modifier -59 may be used to identify the services. The separate and distinct time blocks for the two services may be sequential to one another or split. When the two services are split, the time block for one service may be followed by a time block for the second service followed by another time block for the first service. All Medicare rules for reporting timed services are applicable. For example, the total time is calculated for all related timed services performed. The number of reportable units of service is based on the total time, and these units of service are allocated between the HCPCS/CPT codes for the individual services performed. The physician is not permitted to perform multiple services, each for the minimal reportable time, and report each of these as separate units of service. (e.g., A physician or therapist performs eight minutes of neuromuscular reeducation (CPT code 97112) and eight minutes of therapeutic exercises (CPT code 97110). Since the physician or therapist performed 16 minutes of related timed services, only one unit of service may be reported for one, not each, of these codes.)
 
CMS also added a new example for describing use of modifier -59 to report procedures performed on different anatomic sites:
The procedure-to-procedure edit with column one CPT code 11055 (paring or cutting of benign hyperkeratotic lesion …) and column two CPT code 11720 (debridement of nail[s] by any method; 1 to 5) may be bypassed with modifier -59 only if the paring/cutting of a benign hyperkeratotic lesion is performed on a different digit (e.g., toe) than one that has nail debridement. Modifier -59 should not be used to bypass the edit if the two procedures are performed on the same digit.
 
The manual also include a new example to explain proper coding for infusions involving double lumen catheters:
If both lumina of a double lumen catheter are utilized for infusions of different substances or drugs, only one “initial” infusion CPT code may be reported. The double lumen catheter permits intravenous access through a single vascular site. Thus, it would not be correct to report two “initial” infusion CPT codes, one for each lumen of the catheter.

 

For more information about changes to the NCCI Manual, see CMS’ website. 

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