PROFESSIONAL COMPONENT

1,369 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,369
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
3
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

PROFESSIONAL COMPONENT

  1. 1. UM Office of Billing Compliance Newsletter PHYSICIAN/HOSPITAL Effective January 1, 2008 there will be 242 New CPT codes, 298 revised CPT and 51 CPT codes deleted. Also, Changes in descriptors of some frequently-used Modifiers. Revised CPT Codes for Nuclear Medicine 2008 CPT® Code �78600 Brain imaging, less than 4 static views; �78601 Brain imaging, less than 4 static views; with vascular flow �78605 Brain imaging, minimum 4 static views; �78606 Brain imaging, minimum 4 static views; with vascular flow �78607 Brain imaging, tomographic (SPECT) These were revised editorially to assist in the differentiation of services reported for brain imaging from brain death imaging. When brain death imaging is reported, this service typically requires less than four views. Those studies that require supervision and interpretation of at least four views are the imaging studies for usual evaluation of the brain. � 78608 Brain imaging, positron emission tomography (PET); metabolic valuation � 78609 Brain imaging, positron emission tomography (PET); perfusion evaluation � 78610 Brain imaging, vascular flow only No changes to these CPT codes. 78615 Cerebral vascular flow (78615 has been deleted. To report, use 78610) � 78811 Positron emission tomography (PET) imaging; limited area (e.g., chest, head/neck) � 78812 Positron emission tomography (PET) imaging; skull base to mid-thigh � 78813 Positron emission tomography (PET) imaging; whole body � 78814 Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; limited area (e.g., chest, head/neck) The term “tumor” was removed from the descriptors to allow broader use of the codes and reflect expansion of the use of PET imaging for indications other than tumor imaging. � 78815 Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; skull base to mid-thigh � 78816 Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; whole body PROFESSIONAL COMPONENT Inside This Issue PROFESSIONAL COMPONENT - 2008 CPT Changes Summary - Nuclear Medicine - Radiology - Gastroenterology - Infusion Services - Ob/Gyn Services - Telehealth Services Hospital Component - Radiology - Pathology & Laboratory - Medicine Including E/M Codes - Hospital Coding for E/M Services - Observation Services - Changes in Revenue Codes - Drug Administration Changes - IV Hydration Administration - Changes to the Inpatient only List - Announcements Educational Program for Professional and Hospital - Fingerprinting - Helpline VOLUME 7 ISSUE 4 December 2007
  2. 2. PAGE 2COMPLIANCE NEWSLETTER RADIOLOGY CPT 2008 HAS DELETED THE FOLLOWING CARDIAC RESONANCE IMAGING CODES: o 75552 Cardiac Magnetic Resonance Imaging for morphology, without contrast o 75553 Cardiac Magnetic Resonance Imaging for morphology, with contrast o 77554 Cardiac Magnetic Resonance Imaging for function, with or without morphology; complete study o 77555 Cardiac Magnetic Resonance Imaging for function, with or without morphology; limited study o 77556 Cardiac Magnetic Resonance Imaging for velocity flow mapping THE NEW CPT 2008 FOR CARDIAC RESONANCE IMAGING CODES; o 75557 Cardiac Magnetic Resonance Imaging for morphology, without contrast o 75558 Cardiac Magnetic Resonance Imaging for morphology, without contrast; with flow/velocity quantification o 77559 Cardiac Magnetic Resonance Imaging for morphology, without contrast; with stress imaging o 77560 Cardiac Magnetic Resonance Imaging for morphology, without contrast; with flow/velocity quantification and stress o 77561 Cardiac Magnetic Resonance Imaging for morphology and function without contrast materials(s), followed by contrast material(s) and further sequences; o 75562 Cardiac Magnetic Resonance Imaging for morphology and function without contrast materials(s), followed by contrast material(s) and further sequences; with flow/velocity quantification o 75563 Cardiac Magnetic Resonance Imaging for morphology and function without contrast materials(s), followed by contrast material(s) and further sequences; with stress imaging o 75564 Cardiac Magnetic Resonance Imaging for morphology and function without contrast materials(s), followed by contrast material(s) and further sequences; with flow/velocity quantification and stress PATHOLOGY/LABORATORY Effective January 1st, 2008 New CPT 86356 Mononuclear cell antigen, quantitative (e.g., flow cytometry), not otherwise specified, each antigen, replaces 2007 code 86586 unlisted antigen, each. New codes include; 82107 AFP-L3 fraction isoform and total AFP (including ratio) 87305 Aspergillus 87498 Enterovirus, amplified probe technique 87640 Staphylococcus aureus, amplified probe technique 87641 Staphylococcus aureus, methicillin resistant, amplified probe technique 87653 Streptococcus, group B, amplified probe technique 87808 Trichomonas vaginalis Revised codes include; 87088 Culture, bacterial; quantitative colony count, urine with isolation and presumptive identification of each isolate, urine 88106 Cytopathology, fluids, washings or brushings, except cervical or vaginal; simple filter method with interpretation 88107 Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears and simple filter preparation with interpretation 89060 Crystal identification by light microscopy with or without polarizing lens analysis, tissue or any body fluid (except urine)
  3. 3. PAGE 3COMPLIANCE NEWSLETTER GASTROENTEROLOGY CPT 2008 will delete 43750 (Percutaneous placement of gastrostomy tube, without imaging or endoscopic guidance), and will introduce three new codes that cover insertion of gastrostomy tubes. o 49440 Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report o 49441 Insertion of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report o 49442 Insertion of cecostomy or other colonic tube, percutaneous, under fluoroscopic guidance including contrast injections(s), image documentation and report New CPT Codes include: o 49450 Replacement of gastrostomy or cecostomy (or other colonic) tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report o 49451 Replacement of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report o 49452 Replacement of gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injections(s), image documentation and report o 49460 Mechanical removal of obstructive material from gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostony (or other colonic) tube, any method, under fluoroscopic guidance including contrast injection(s), if performed , image documentation and report INFUSION SERVICES New CPT Codes include: o 90769 Subcutaneous infusion for therpary or prophylaxis (specify substance or drug); initial, up to one hour, including pump set-up and establhisment of subcutaneous infusion site(s) o + 90770 each additional hour, (List separately in addition to code for primary procedure) o +90771 additional pump set-up with establhisment of new subcutaneous infusion site(s) (List separately in addition to code for primary) The code below should be used in addition to 90774 intravenous push , single or initial substance/drug. o +90776 each additional sequential intravenous push of the same substance/drug provided in a facility )(List separately in addition to code for primary procedure) The difference of this new code 90776 and 90775, is that 90775 covers additional pushes of a new drug, while 90776 covers more pushes of the same drug.
  4. 4. PAGE 4COMPLIANCE NEWSLETTER OB/GYN SERVICES There will be new codes for paravaginal repair via vaginal approach (57285) and laparascopic approach (57423). The following are four (4) new codes for laparascopic hysterectomy: o 58570 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less o 58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) o 58572 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250g o 58573 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250g; with removal of tube(s) and/or ovary(s) MEDICARE TELEHEALTH SERVICES Effective January 1, 2008, the Telehealth modifiers “GT” (via interactive audio and video telecommunications system) and modifier “GQ” (via asynchronous telecommunications system) are valid when billed with HCPCS code 96116 (Neurobehavioral status exam) Medicare Telehealth Services: o Consultations (99241 – 99245 and 99251 – 99255) o Office of other outpatient visits (99201 – 99205 and 99212 – 99215) o Individual Psychotherapy (90804 – 90809) o Pharmacologic Management (90862) o Psychiatric Diagnostic interview examination (90901) o End Stage Renal Disease (ESRD) related services (G0308, G0309, G0311, G0312, G0314, G0315, G0317, and G0318) o Individual Medical Nutrition Therapy (G0270, 97802 and 97803) o Neurobehavioral status exam (96116) Effective January 1, 2008
  5. 5. PAGE 5COMPLIANCE NEWSLETTER HOSPITAL COMPONENT Overview of CPT®/HCPCS Changes and Updates for CY 2008 Hospital Outpatient Prospective Payment System. The CPT/HCPCS code changes for 2008 include approximately 242 new codes, 55 deleted codes and 305 revised codes. Highlights from the major sections are listed in this newsletter. Radiology The Radiology section contains 8 new codes, 7 deleted codes and 24 revised codes. Highlights from the Radiology section include:  Terminology changes to the CTA codes (70496, 70498, 71275, 72191, 73206, 73706, and 74175) CPT® codes. Primarily, the terminology involves the removal of verbiage indicating “without contrast material(s)” and “further sections”.  For the above codes, verbiage was added indicating they include “non-contrast images, if performed and image post processing”.  Cardiac MRI morphology, function and velocity codes, 75552-75556 have been deleted and replaced with 75557-75564.  In Nuclear Medicine, CPT® 78615 “cerebral vascular flow” has been deleted and replaced with CPT® 78610.  CPT® 78811 and 78814 had terminology revisions to delete the wording “tumor imaging”. Pathology and Laboratory Highlights from the Laboratory/Pathology section include: The Pathology and Laboratory section contains 11 new codes, 0 deleted codes. Highlights of the new Laboratory codes include:  Other than the additions, there are no significant changes except the deletion of CPT® 86586, “unlisted antigen, each”.  Additions for the Laboratory can be viewed in Appendix B of the 2008 CPT® Manual. Medicine (Including Clinic Visits) The Medicine section had 33 new codes added, 5 codes deleted and there was terminology revisions to 128 codes. The consultation codes, 99241-99245, have had a change in status indicator. For 2008, these codes will be a SI “B”, meaning they are not recognized under OPPS.
  6. 6. PAGE 6COMPLIANCE NEWSLETTER Hospital Coding for Clinic Visit Services CMS still has not created national clinic visits guidelines but did indicate hospitals were to continue to implement and follow their own internal guidelines. Hospitals will continue to distinguish between new and established patients according to CPT code descriptors. As stated in the April 7, 2000 OPPS Final Rule, CMS defined the meaning of “new” and “established” as whether or not a patient already has hospital medical record. Definition New and Established Patient for Hospitals New Patient A patient who has no medical record at the hospital. Established Patient A patient who has had a medical record created at the hospital within the past 3 years. Bill for all Services As per a CMS long-standing policy, hospitals are encouraged to report HCPCS and CPT® codes and associated charges for all services they provide taking into consideration all CPT®, OPPS and local contracture instructions, regardless of whether payment for those codes are packaged or separately reimbursed. Observation Services Although reimbursement for observation services changed for 2008, the reporting criteria did not. The following criteria will remain in effect for CY 2008: Observation time must be documented in the Physician Observation Order Form. A patient’s time in observation begins with the patient’s admission to an observation bed. A patient’s time in observation ends when all clinical or medical interventions have been completed, including follow-up care furnished by hospital staff and physicians that may take place after a physician has ordered the patient to be released or admitted as an inpatient or discharged home.
  7. 7. PAGE 7COMPLIANCE NEWSLETTER NEW DRUG HCPCS CODES There were 7 new drug HCPCS codes that were implemented in July, 2007. The temporary Q codes for these drugs were changed to a J code, effective January 1, 2008 New HCPCS J-Code Effective January 1, 2008 HCPCS Q-Code Long Descriptor Final CY 2008 Status Indicator Final CY 2008 APC J1568 Q4087 Injection, immune globulin, (Octogam), intravenous, non- lyophilized, (e.g. liquid), 500 mg K 0943 J1569 Q4088 Injection, immune globulin, (Gammagard), intravenous, non- lyophilized, (e.g. liquid), 500 mg K 0944 J2791 Q4089 Injection, rho(d) immune globulin (human), (Rhophylac), intravenous, 100 iu K 0945 J1571 Q4090 Injection, hepatitis b immune globulin (Hepagam B), intramuscular, 0.5 ml K 0946 J1572 Q4091 Injection, immune globulin, (Flebogamma), intravenous, non- lyophilized, (e.g. liquid), 500 mg K 0947 J1561 Q4092 Injection, immune globulin, (Gamunex), intravenous, non- lyophilized, (e.g. liquid), 500 mg K 0948 J3488 Q4095 Injection, zoledronic acid (Reclast), 1 mg K 0951 Changes in Revenue Codes For 2008, CMS has revised the list of packaged revenue codes. The following revenue codes were deleted as packaged since OPPS hospitals cannot report implantable devices in these revenue codes: Ø 0274 Prosthetic/Orthotic devices Ø 0290 Durable medical equipment The following revenue code was added as a packaged revenue code since charges classed in this revenue code are typically incidental supplies that hospitals provide to patients at discharge for use at home for a brief period of time. Ø 0274 Take Home Supplies Ø 0274 Take Home Supplies Drug Administration CPT Codes Changes From the hydration, therapeutic, prophylactic, and diagnostic injections and infusions section Physician work work related to hydration, injection, and infusion services predominantly involves affirmation of treatment plan and direct supervision of staff. These codes are not intended to be reported by the physician in the facility setting. The initial code should be selected using a hierarchy whereby: Chemo services are primary to therapeutic, prophylactic, and diagnostic services which are primary to hydration services. Infusions are primary to pushes, which are primary to injections. The hierarchy does NOT apply to physician reporting.
  8. 8. PAGE 8COMPLIANCE NEWSLETTER IV Hydration Administration The terminology for CPT 90760 has been revised for 2008. Currently CPT 90760 indicates the service is for “up to 1 hour”. However, for 2008, the terminology was revised to read “IV infusion, hydration, initial, 31 minutes to 1 hour”. Ø As per the CPT parenthetical notes, 90760 cannot be reported for IV hydration of 30 minutes or less. Hydration provided before and/or after chemotherapy is appropriate to charge, but not hydration running during chemotherapy. CPT code 90769: subcutaneous infusion for therapy or prophylaxis; initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s) CPT code 90770: subcutaneous infusion for therapy or prophylaxis; each additional hour (Report with CPT code 90769) This is for infusions greater than 30 minutes beyond one hour increments (similar to how additional hours of other infusion codes are reported) CPT code 90771: subcutaneous infusion for therapy or prophylaxis; additional pump set-up with establishment of new subcutaneous infusion site(s) (Report with CPT code 90769)( Report CPT code 90771 once per encounter) CPT code 90776: therapeutic, prophylactic or diagnostic injection (specify substance or drug), each additional sequential intravenous push of the same substance/drug provided in a facility (List separately in addition to code for primary procedure) - New code for facility reporting only to report each additional sequential intravenous push of the same Substance or drug provided in a facility - Established to address substance reporting restrictions in the facility setting - Do not report CPT code 90776 for a push performed with 30 minutes of a reported push of the same substance or drug Inpatient List Status Indicator C Services that are only paid when provided in an inpatient setting due to the nature of the procedure and need for postoperative recover time/monitoring. CMS annually reviews the inpatient-only list and removes services and places them in APC groups if appropriate. Thirteen (13) procedures will be assigned to clinical APC’s: 21360, 21365, 21385, 25931, 27006, 27720, 27722, 50580, 51535, 58805, 60271, 61770, 69970
  9. 9. PAGE 9COMPLIANCE NEWSLETTER ANNOUNCEMENTS Our Billing Compliance Educational Program is now online by accessing the Ulearn website at: www.Ulearn.miami.edu. - Log on to Ulearn with your User ID (C number) and password - Select Learn (green menu bar across the top of the page) - Select Catalog. The catalog contains a list of different topic areas. The Office of Billing Compliance is listed under “Compliance”. - Click on “Office of Billing Compliance and register for any or all of the above CBLs. Coding, Billing and Documentation Training Modules (CBLs) available of the Professional Component; - Critical Care Services - Evaluation and Management (E&M) Services Module I - Evaluation and Management (E&M) Services Module II - Major Surgery Global Fee and Minor Surgery Rules - Medicare Rule for Teaching Physicians Coding, Billing and Documentation Training Modules (CBLs) available of the Hospital Component; - Hospital Compliance Orientation - Observation Billing & Documentation Guidelines - Facility Fee – Clinic Visits Billing & Documentation Guidelines For Residents, Fellows and other non-UM employeesthe links to the CBLs are as follows: - http://pdto.miami.edu/external/compliance/CriticalCareServicesWeb/index.html - http://pdto.miami.edu/external/compliance/EMServices_Module1Web/index.html - http://pdto.miami.edu/external/compliance/EMServices_Module2Web/index.html - http://pdto.miami.edu/external/compliance/MajorSurgeryGlobalFeeWeb/index.html - http://pdto.miami.edu/external/compliance/MedicareRuleWeb/index.html
  10. 10. PAGE 10COMPLIANCE NEWSLETTER _______________________________ Our office offers Fingerprinting services to all UM personnel at no charge. Monday-Friday from 10:00 AM – 12:00 PM and 2:00 PM – 4:00 PM To schedule an appointment, please call 305-243-5842 ________________________________________________________________________________ If you have any billing questions or concerns, please call our Help Line: (305) 243-HELP or Toll Free 1-877-415-HELP Calls may remain Anonymous. Office of Billing Compliance Gemma Romillo/Executive Director Iliana De La Cruz/Physician Billing Lilian Eymann/Hospital Billing Office: (305) 243-5842 Fax: (305) 243-6487 Professional Arts Center (PAC) Suite 404 1150 N.W. 14th Street Miami, Florida 33136 ______________________________________________________________________________________

×