Cardiac Resynchronization Therapy - ASC Payment details for CY 2012

Effective for services furnished on or after January 1, 2012, cardiac resynchronization therapy involving an implantable cardioverter defibrillator (CRT-D) will be recognized as a single, composite service combining implantable cardioverter defibrillator procedures (described by Current Procedural Terminology (CPT) code 33249 (Insertion or repositioning of electrode lead(s) for single or dual chamber pacing cardioverter-defibrillator and insertion of pulse generator)) and pacing electrode insertion procedures (described by CPT code 33225 (Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator (including upgrade to dual chamber system))) when performed on the same Date of Service in an ASC.

The payment rate for CRT-D services in ASCs will be based on the OPPS payment rate applicable to APC 0108 and ASCs will use the HCPCS Level II G-code G0448 (Insertion or replacement of a permanent pacing cardioverter-defibrillator system with transvenous lead(s) single or dual chamber with insertion of pacing electrode, cardiac venous system, for left ventricular pacing) for proper reporting when the procedures described by CPT codes 33225 and 33249 are performed on the same Date of Service. When these procedures are not performed on the same Date of Service, the ASC payment rate will be based on the standard APC assignment for each service and ASCs should report the appropriate CPT codes for the individual procedures.

Reference: http://www.cms.gov/MLNMattersArticles/downloads/MM7682.pdf

2012 List of Deleted Lab codes

88107 Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears and filter preparation with interpretation

88318 Determinative histochemistry to identify chemical components (eg, copper, zinc)

The Medicare EHR Incentive Program - Important informations

February 29, 2012 – Last day for eligible professionals to register and attest to receive an Incentive Payment for calendar year (CY) 2011.To get the maximum incentive payment, Medicare eligible professionals must begin participation by 2012. The maximum bonus for eligible professional is $44,000 for Medicare and $63,750 for Medicaid.

Professionals who are eligible to receive Medicare EHR incentives

Doctors of Medicine or Osteopathy

Doctors of Dental Surgery or Dental Medicine

Doctors of Podiatric Medicine

Doctors of Optometry

Chiropractors

Please note: EPs may NOT be hospital-based. This is defined as any provider who furnishes 90% or more of their services in a hospital setting (inpatient or emergency room).

Professionals who are eligible to receive Medicaid EHR incentives

Physicians

Nurse Practitioners

Certified Nurse - Midwife

Dentists

Physicians Assistants who practice in a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) that is led by a Physician Assistant.

Please note: Medicaid EPs must also:

Have a minimum of 30% Medicaid patient volume (20% minimum for pediatricians), OR

Practice predominantly in a FQHC or RHC and have at least 30% patient volume to needy individuals.

*EPs can receive the maximum incentives by Choosing Medicaid EHR program.*

FAQs

Is my practice eligible to receive incentive payments through the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs?

Incentive payments are not made to practices but to individual eligible professionals (EPs). For more information about who is eligible to participate, please visit http://www.cms.gov/EHRIncentivePrograms/15_Eligibility.asp#TopOfPage.

Can eligible professionals (EPs) receive electronic health record (EHR) incentive payments from both the Medicare and Medicaid programs?

Not for the same year. If an EP meets the requirements of both programs, they must choose to receive an EHR incentive payment under either the Medicare program or the Medicaid program. After a payment has been made, the EP may only switch programs once before 2015.

What is the maximum incentive an eligible professional (EP) can receive under the Medicaid Electronic Health Record (EHR) Incentive Program?

EPs who adopt, implement, upgrade, and meaningfully use EHRs can receive a maximum of $63,750 in incentive payments from Medicaid over a six year period (Note: There are special eligibility and payment rules for pediatricians). EPs must begin receiving incentive payments by calendar year 2016. Know more....

KNOW THE ADVANTAGES OF EHR...Get started registering at https://ehrincentives.cms.gov/hitech/login.action

Annual alcohol screening - New HCPCS codes G0442 and G0443

Effective for claims with dates of service October 14, 2011, and later, CMS would cover annual alcohol screening, and for those that screen positive, up to four, brief, face-to-face behavioral counseling interventions per year for Medicare beneficiaries, including pregnant women:

• who misuse alcohol, but whose levels or patterns of alcohol consumption do not meet criteria for alcohol dependence (defined as at least three of the following: tolerance, withdrawal symptoms, impaired control, preoccupation with acquisition and/or use, persistent desire or unsuccessful efforts to quit, sustains social, occupational, or recreational disability, use continues despite adverse consequences); and,

• who are competent and alert at the time that counseling is provided; and,

• whose counseling is furnished by qualified primary care physicians or other primary care practitioners in a primary care setting.

HCPCS codes and effective date

Two new G codes, G0442 (Annual Alcohol Misuse Screening, 15 minutes), and G0443 (Brief face-to-face behavioral counseling for Alcohol Misuse, 15 minutes), are effective October 14, 2011, and will appear in the January quarterly update of the Medicare Physician Fee Schedule Database (MPFSDB) and Integrated Outpatient Code Editor (IOCE). For claims with Dates of Service on or after October 14, 2011, through December 31, 2011, Medicare contractors will use their pricing to pay for G0442 and/or G0443.

Deductible and coinsurance do not apply.

Applicable POS

For purposes of this covered service, the following place of service (POS) codes are applicable:

11-Physician’s Office

22-Outpatient Hospital

49-Independent Clinic

71-State or local public health clinic

Can we bill both G0442 and G0443 on the same day?

Medicare will allow payment for both G0442 and G0443 on the same date (except in RHCs and FQHCs), but will not pay for more than one G0443 service on the same date.

Coverage Limitations

Medicare will track payments for G0442 screening services and G0443 counseling services so as to not permit payment for G0442 more than once in a 12-month period, and for G0443 no more than 4 times in a 12-month period, beginning with the date of the G0442 service.

How to bill for Incomplete Colonoscopies? Can we report CPT 45330 for incomplete colonoscopies?

An incomplete colonoscopy, for example, the inability to extend beyond the splenic flexure, is billed and paid using colonoscopy code 45378 with modifier “-53.” The Medicare physician fee schedule database has specific values for code 45378-53. These values are the same as for code 45330, sigmoidoscopy, as failure to extend beyond the splenic flexure means that a sigmoidoscopy rather than a colonoscopy has been performed. However, code 45378-53 should be used when an incomplete colonoscopy has been done and not CPT code 45330 since the MPFSDB (Medicare Physician Fee Schedule Database) indicators are different for codes 45378 and 45330.

2012 New and Deleted Q codes list

Added Q - Codes

Q0162 Ondansetron 1 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q2043 Sipuleucel-T, minimum of 50 million autologous cd54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion (effective 07/01/11)

Q4122 Dermacell, per square centimeter

Q4123 AlloSkin RT, per square centimeter

Q4124 Oasis ultra tri-layer wound matrix, per square centimeter

Q4125 Arthroflex, per square centimeter

Q4126 Memoderm, per square centimeter

Q4127 Talymed, per square centimeter

Q4128 FlexHD or AlloPatchHD, per square centimeter

Q4129 Unite Biomatrix, per square centimeter

Q4130 Strattice TM, per square centimeter

Deleted Q - codes

Q0179 Ondansetron hydrochloride 8 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q2040 Injection, incobotulinumtoxin a, 1 unit

Q2041 Injection, von Willebrand factor complex (human), Wilate, 1 i.u. VWF:RCO

Q2042 Injection, hydroxyprogesterone caproate, 1 mg

Q2044 Injection, belimumab, 10 mg

Also see list of added and Deleted G codes

2012 New and Deleted G codes

Added G - codes

G0442 Annual alcohol misuse screening, 15 minutes (effective 10/17/11)

G0443 Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes (effective 10/17/11)

G0444 Annual depression screening, 15 minutes (effective 10/14/11)

G0445 High intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes (effective 11/08/11)

G0446 Intensive behavioral therapy to reduce cardiovascular disease risk, individual, face-to-face, bi-annual, 15 minutes (effective 11/08/11)

G0447 Face-to-face behavioral counseling for obesity, 15 minutes (effective 11/29/11)

G0448 Insertion or replacement of a permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber with insertion of pacing electrode, cardiac venous system, for left ventricular pacing

G0449 Annual face-to-face obesity screening, 15 minutes (effective 11/29/11)

G0450 Screening for sexually transmitted infections, includes laboratory tests for chlamydia, gonorrhea, syphilis and hepatitis b (effective 11/08/11)

G0451 Development testing, with interpretation and report, per standardized instrument form

G9156 Evaluation for wheelchair requiring face to face visit with physician

Deleted G - codes

G0440 Application of tissue cultured allogeneic skin substitute or dermal substitute; for use on lower limb, includes the site preparation and debridement if performed; first 25 sq cm or less

G0441 Application of tissue cultured allogeneic skin substitute or dermal substitute; for use on lower limb, includes the site preparation and debridement if performed; each additional 25 sq cm

G9041 Rehabilitation services for low vision by qualified occupational therapist, direct one-on-one contact, each 15 minutes

G9042 Rehabilitation services for low vision by certified orientation and mobility specialists, direct one-on-one contact, each 15 minutes

G9043 Rehabilitation services for low vision by certified low vision rehabilitation therapist, direct one-on-one contact, each 15 minutes

G9044 Rehabilitation services for low vision by certified low vision rehabilitation teacher, direct one-on-one contact, each 15 minutes

Please see complete list of 2012 CPT code changes