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An Ambulatory Surgical Center Payment System (ASC PS) update that took effect July 1, 2019, changes billing instructions for various payment policies and codes. Here is what you need to know to properly bill Medicare for these services and supplies. New CPT Category III Codes Effective July 1, 2019, the Centers for Medicare & Medicaid […]
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Deleted
0057U Oncology (solid organ neoplasia), mRNA, gene expression profiling by massively parallel sequencing for analysis of 51 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a normalized percentile rank
New
0084U Red blood cell antigen typing, DNA, genotyping of 10 blood groups with phenotype prediction of 37 red blood cell antigens
0085U Cytolethal distending toxin B (CdtB) and vinculin IgG antibodies by immunoassay (ie, ELISA)
0086U Infectious disease (bacterial and fungal), organism identification, blood culture, using rRNA FISH, 6 or more organism targets, reported as positive or negative with phenotypic minimum inhibitory concentration (MIC)-based antimicrobial susceptibility
0087U Cardiology (heart transplant), mRNA gene expression profiling by microarray of 1283 genes, transplant biopsy tissue, allograft rejection and injury algorithm reported as a probability score
0088U Transplantation medicine (kidney allograft rejection), microarray gene expression profiling of 1494 genes, utilizing transplant biopsy tissue, algorithm reported as a probability score for rejection
0089U Oncology (melanoma), gene expression profiling by RTqPCR, PRAME and LINC00518, superficial collection using adhesive patch(es)
0090U Oncology (cutaneous melanoma), mRNA gene expression profiling by RT-PCR of 23 genes (14 content and 9 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a categorical result (ie, benign, indeterminate, malignant)
0091U Oncology (colorectal) screening, cell enumeration of circulating tumor cells, utilizing whole blood, algorithm, for the presence of adenoma or cancer, reported as a positive or negative result
0092U Oncology (lung), three protein biomarkers, immunoassay using magnetic nanosensor technology, plasma, algorithm reported as risk score for likelihood of malignancy
0093U Prescription drug monitoring, evaluation of 65 common drugs by LC-MS/MS, urine, each drug reported detected or not detected
0094U Genome (eg, unexplained constitutional or heritable disorder or syndrome), rapid sequence analysis
0095U Inflammation (eosinophilic esophagitis), ELISA analysis of eotaxin-3 (CCL26 [C-C motif chemokine ligand 26]) and major basic protein (PRG2 [proteoglycan 2, pro eosinophil major basic protein]), specimen obtained by swallowed nylon string, algorithm reported as predictive probability index for active eosinophilic esophagitis
0096U Human papillomavirus (HPV), high-risk types (ie, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68), male urine
0097U Gastrointestinal pathogen, multiplex reverse transcription and multiplex amplified probe technique, multiple types or subtypes, 22 targets (Campylobacter [C. jejuni/C. coli/C. upsaliensis], Clostridium difficile [C. difficile] toxin A/B, Plesiomonas shigelloides, Salmonella, Vibrio [V. parahaemolyticus/V. vulnificus/V. cholerae], including specific identification of Vibrio cholerae, Yersinia enterocolitica, Enteroaggregative Escherichia coli [EAEC], Enteropathogenic Escherichia coli [EPEC], Enterotoxigenic Escherichia coli [ETEC] lt/st, Shiga-like toxin-producing Escherichia coli [STEC] stx1/stx2 [including specific identification of the E. coli O157 serogroup within STEC], Shigella/Enteroinvasive Escherichia coli [EIEC], Cryptosporidium, Cyclospora cayetanensis, Entamoeba histolytica, Giardia lamblia [also known as G. intestinalis and G. duodenalis], adenovirus F 40/41, astrovirus, norovirus GI/GII, rotavirus A, sapovirus [Genogroups I, II, IV, and V])
0098U Respiratory pathogen, multiplex reverse transcription and multiplex amplified probe technique, multiple types or subtypes, 14 targets (adenovirus, coronavirus, human metapneumovirus, influenza A, influenza A subtype H1, influenza A subtype H3, influenza A subtype H1-2009, influenza B, parainfluenza virus, human rhinovirus/enterovirus, respiratory syncytial virus, Bordetella pertussis, Chlamydophila pneumoniae, Mycoplasma pneumoniae)
0099U Respiratory pathogen, multiplex reverse transcription and multiplex amplified probe technique, multiple types or subtypes, 20 targets (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus, coronavirus OC43, human metapneumovirus, influenza A, influenza A subtype, influenza A subtype H3, influenza A subtype H1-2009, influenza, parainfluenza virus, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, human rhinovirus/enterovirus, respiratory syncytial virus, Bordetella pertussis, Chlamydophila pneumonia, Mycoplasma pneumoniae)
0100U Respiratory pathogen, multiplex reverse transcription and multiplex amplified probe technique, multiple types or subtypes, 20 targets (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)
0101U Hereditary colon cancer disorders (eg, Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis), genomic sequence analysis panel utilizing a combination of NGS, Sanger, MLPA, and array CGH, with MRNA analytics to resolve variants of unknown significance when indicated (15 genes [sequencing and deletion/duplication], EPCAM and GREM1 [deletion/duplication only])
0102U Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer), genomic sequence analysis panel utilizing a combination of NGS, Sanger, MLPA, and array CGH, with MRNA analytics to resolve variants of unknown significance when indicated (17 genes [sequencing and deletion/duplication])
0103U Hereditary ovarian cancer (eg, hereditary ovarian cancer, hereditary endometrial cancer), genomic sequence analysis panel utilizing a combination of NGS, Sanger, MLPA, and array CGH, with MRNA analytics to resolve variants of unknown significance when indicated (24 genes [sequencing and deletion/duplication], EPCAM [deletion/duplication only])
0104U Hereditary pan cancer (eg, hereditary breast and ovarian cancer, hereditary endometrial cancer, hereditary colorectal cancer), genomic sequence analysis panel utilizing a combination of NGS, Sanger, MLPA, and array CGH, with MRNA analytics to resolve variants of unknown significance when indicated (32 genes [sequencing and deletion/duplication], EPCAM and GREM1 [deletion/duplication only])
New and Revised Category III Codes
The following Category III codes were accepted at the September 2018 CPT Editorial Panel meeting for the 2020 CPT® production cycle. These 20 new codes and one code revision also go into effect on July 1, 2019:
Revised
0402T Collagen cross-linking of cornea, (including removal of the corneal epithelium and intraoperative pachymetry, when performed) (Report medication separately)
New
0543T Transapical mitral valve repair, including transthoracic echocardiography, when performed, with placement of artificial chordae tendineae
0544T Transcatheter mitral valve annulus reconstruction, with implantation of adjustable annulus reconstruction device, percutaneous approach including transseptal puncture
0545T Transcatheter tricuspid valve annulus reconstruction with implantation of adjustable annulus reconstruction device, percutaneous approach
0546T Radiofrequency spectroscopy, real time, intraoperative margin assessment, at the time of partial mastectomy, with report
0547T Bone-material quality testing by microindentation(s) of the tibia(s), with results reported as a score
0548T Transperineal periurethral balloon continence device; bilateral placement, including cystoscopy and fluoroscopy
0549T unilateral placement, including cystoscopy and fluoroscopy
0550T removal, each balloon
0551T adjustment of balloon(s) fluid volume
0552T Low-level laser therapy, dynamic photonic and dynamic thermokinetic energies, provided by a physician or other qualified health care professional
0553T Percutaneous transcatheter placement of iliac arteriovenous anastomosis implant, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention
0554T Bone strength and fracture risk using finite element analysis of functional data, and bone-mineral density, utilizing data from a computed tomography scan; retrieval and transmission of the scan data, assessment of bone strength and fracture risk and bone mineral density, interpretation and report
0555T retrieval and transmission of the scan data
0556T assessment of bone strength and fracture risk and bone mineral density
0557T interpretation and report
0558T Computed tomography scan taken for the purpose of biomechanical computed tomography analysis
0559T Anatomic model 3D-printed from image data set(s); first individually prepared and processed component of an anatomic structure
0560T each additional individually prepared and processed component of an anatomic structure (List separately in addition to code for primary procedure)
0561T Anatomic guide 3D-printed and designed from image data set(s); first anatomic guide
0562T each additional anatomic guide (List separately in addition to code for primary procedure)
Source: https://www.aapc.com/blog/46433-update-your-cpt-2019-code-book-with-the-latest-additions-and-revisions/
ASP Drug Pricing Files Update Released for July 2019 The Centers for Medicare & Medicaid Services (CMS) just released the updated 2019 ASP drug pricing files for July, available at CMS.gov. These files contain the payment amounts to be used to pay for Part B covered drugs in the third quarter. Updated July 2019 payment limits […]
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The electronic clinical quality measure (eCQM) specifications for the 2020 reporting/performance period are now available. Eligible reporting entities should, “Work with your coding department and health information technology (IT) vendor to ensure your systems have been updated to the latest code versions,” during pre-check, advises the Centers for Medicare & Medicaid Services (CMS). Do the eCQM […]
The post Checklists Facilitate eCQM Specifications Update appeared first on AAPC Knowledge Center.
Get out your 2019 CPT® code books. You have some code changes to make. Effective July 1, 2019, the American Medical Association (AMA) is adding 21 new lab codes and deleting one in Appendix O, Multianalyte Assays with Algorithmic Analyses and Proprietary Laboratory Analyses. Deleted 0057U Oncology (solid organ neoplasia), mRNA, gene expression profiling by […]
The post Update Your CPT 2019 Code Book with the Latest Additions and Revisions appeared first on AAPC Knowledge Center.
For established patient office/outpatient visits, when relevant information is already contained in the medical record, providers may choose to focus their documentation on what has changed since the last visit, or on pertinent items that have not changed, and need not re-record the defined list of required elements if there is evidence that the practitioner reviewed the previous information and updated it as needed. Practitioners should still review prior data, update as necessary
Code changes for the April update to the 2019 Medicare Physician Fee Schedule Database (MPFSDB) are effective for dates of service on and after Jan. 1, 2019. Medicare Administrative Contractors (MAC) will not search their files to retract payment for claims already paid or to retroactively pay claims. To ensure proper claims payment, providers will […]
The post Don’t Wait to Implement April Code Update appeared first on AAPC Knowledge Center.
The Centers for Disease Control and Prevention (CDC) announced Tuesday during a telebriefing that it will track the long-term outcomes of all acute flaccid myelitis (AFM) cases from this year and previous years. As it stands, the number of actual AFM cases and long-term outcomes are unknown because of inadequate tracking. The CDC is taking […]
The post Important Update on Acute Flaccid Myelitis appeared first on AAPC Knowledge Center.
Following up on our September 4th, 2018 post “MGMA Opposes Proposal to Consolidate E/M Codes”, The Coding Network has been actively tracking the status of the sweeping changes to the Physician Fee Schedule for 2019 proposed by the Centers for Medicare & Medicaid Services. The complete language of CMS’s proposed rule can be found online at https://www.regulations.gov/document?D=CMS-2018-0076-0621. According to the site, over 15,000 comments from the public have been submitted in response to the proposed rule. Please click here to view the comment letter submitted by The Coding Network. Amongst the many proposed changes, CMS has proposed significant revisions to existing documentation requirements and levels of reimbursement for Evaluation & Management visits. The changes could result in dramatic declines in reimbursements for certain specialties. The Coding Network strongly encourages providers and healthcare managers and administrators to familiarize themselves with the substance of the proposed rule. Many healthcare organizations, including MGMA, AMA and medical specialty organizations, are organizing efforts to address the issues at the center of CMS’s proposed rule.
Please Read The Attachment Here!
The post Update: CMS’s Proposed Changes to the Physician Fee Schedule for 2019 appeared first on The Coding Network.