For the Week of February 8, 2016

When can the following codes be reported together?

93656    Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia including left or right atrial pacing/recording when necessary, right ventricular pacing/recording when necessary, and His bundle recording when necessary with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation

+93655   Intracardiac catheter ablation of a discrete mechanism of arrhythmia which is distinct from the primary ablated mechanism, including repeat diagnostic maneuvers, to treat a spontaneous or induced arrhythmia (List separately in addition to code for primary procedure)

Code 93655 may be reported with 93656 when additional non-atrial fibrillation tachycardia is separately diagnosed after pulmonary vein isolation.

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Has CMS issued the 2016 travel fee allowances yet? If so, can you provide?

For 2016, the per flat-rate trip basis travel allowance is $9.90, and the minimum per-mile travel allowance is $0.99 (down from $1.03 in 2015), which should be used in situations where the average trip to the patient’s home (or patients’ homes) is longer than 20 miles round trip. MACs have the option of establishing a higher per-mile rate if local conditions warrant it. 

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Were there any new technology add-on payments listed in the inpatient PPS that took effect on October 1, 2015? 

The inpatient prospective payment system (IPPS) final rule authorized a new technology add-on payment for bilatumonmab, which was approved by the Food & Drug Administration (FDA) December, 2014, for the treatment of a form of B-cell acute lymphoblastic leukemia. The maximum add-on payment for the drug during fiscal year (FY) 2016 is $27,017.85 per case.

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Is a separate code allowed for post-procedure mammograms?

This Medicare policy has changed yearly since 2013 from not allowing it at all, to allowing it with stereotactic, ultrasound, and magnetic resonance (MR) guided procedures, to allowing it only with ultrasound and procedures guided by MR. 

The 2016 NCCI Policy Manual, Chapter 9, has reverted back to the 2014 policy statement that allows separate coding of a post-procedure mammogram with all but the mammogram-guided localization. Item 11 says the following: 

If a breast biopsy, needle localization wire, metallic localization clip, or other breast procedure is performed with mammographic guidance (e.g., 19281, 19282), the physician should not separately report a post procedure mammography code (e.g., 77051, 77052, 77055–77057, G0202–G0206) for the same patient encounter. The radiologic guidance codes include all imaging by the defined modality required to perform the procedure.

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What is the CPT code for oxygen? 

There is no CPT code for oxygen, which is classified as a medical supply under Medicare Part A

and Part B, and providers are reimbursed for it on the basis of reasonable cost.. Bill it with the revenue code 0271, designating it as a supply, and bill it in “measurable” units, such as per liter, per hour, per quarter hour, per minute. 

Also, make sure there is a written order for the oxygen. “PRN oxygen” is not satisfactory for Medicare reimbursement. While physicians are accustomed to including this “as needed” descriptor for certain items and services, Medicare guidelines specifically prohibit payment for oxygen used and ordered only on a PRN basis.

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Will RACs ever investigate Part C Medicare Advantage claims? 

Although Congress mandated a Part C (Medicare Advantage) recovery audit contractor (RAC) in the Patient Protection and Affordable Care Act of 2010, the Centers for Medicare & Medicaid Services (CMS) just got around to issuing a request for information (RFI). 

As CMS currently envisions it, the Medicare Part C RAC will undertake two types of audits: comprehensive risk-adjusted data validation (RADV) and condition-specific RADV. The Medicare Advantage organizations will submit medical record documentation to CMS for each of the diagnoses that they reported for each enrollee in the audit sample. CMS also plans to extrapolate an overpayment estimate for each audited contract and recover money based on this estimate. 

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