For the Week of February 20, 2017

If several pharmacies, each with their own national provider identifier (NPI), are owned by the same covered organization health care provider (payee), may the X12 835 payment and remittance advice for these pharmacies be consolidated and sent to the covered organization health care provider (i.e., the “parent”)?

According to the Centers for Medicare & Medicaid Services (CMS), payment and remittances for multiple pharmacies, each with their own NPIs, may be consolidated when the receiving entity (payee) shares the same taxpayer identification number (TIN) as those pharmacies. The pharmacies are subparts of the payee.

In order for the payment and remittance to be consolidated, states CMS in FAQ2189, “The payee identification at the Header Level must be the NPI of the entity designated to receive the payment.” CMS also notes that “while the consolidation of remittances is technically feasible, this fact does not obligate a payer to execute such consolidation – this is a business decision and contract issue to be negotiated between trading partners.”

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In the 2/13/17 question you said 77063 could be billed with G0202 because it was digital and not with 77067 because it was analog. Those descriptions are no longer part of the code. I have been told by multiple sources to use CPT 77063 for ALL screening mammograms except Medicare which is the G0202 until 2018. Is this not correct?

If a payer accepts the CPT mammogram codes, then 77063 may be billed with 77067. If the payer is following Medicare’s lead and requiring the G codes for mammogram, then 77063 would be reported with G0202. We are hearing that many payers are following Medicare, but each practice should check with its own major payers.

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Can you provide guidance on use of the new K code for CPAPs?

Effective April 1, 2017, the Centers for Medicare & Medicaid Services (CMS) will establish a new “K” code for the continuous positive airway pressure (CPAP) device bundle, which includes the CPAP device and all accessories. These are subject to the durable medical equipment, prosthetic, orthotic and supplies (DMEPOS) competitive bidding program in specified competitive bidding areas. The addition of the code will allow the DME MACs to correctly adjudicate claims, according to CMS.

 

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What is the performance period for the value modifier in 2017 and 2018?

Calendar year (CY) 2015 is the performance period for the value modifier (VM) that will be applied to payments in 2017, and 2016 is the performance period for the VM that will be applied to payments in 2018.

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For the new lab payments, what codes will we use to identify the new and existing ADLTs?

Either the American Medical Association will create CPT codes or the Centers for Medicare & Medicaid Services (CMS) will create HCPCS level II codes. These will be used to identify new and existing advanced diagnostic laboratory tests (ADLTs) and clinical diagnostic laboratory tests (CDLTs)—those that are not ADLTs—that the Food & Drug Administration cleared or approved.

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Can we bill codes 93620 and 93656 (both relate to comprehensive electrophysiologic evaluation) together? Are there any other codes that may be billed with 93656, or is it all encompassing?

According to the CPT book, 93620 may not be coded with 93656. When performed, you can code one of the following with 93656, but these two codes cannot be assigned in the same encounter:

93609 Intraventricular and/or intra-atrial mapping of tachycardia site(s) with catheter manipulation to record from multiple sites to identify origin of tachycardia (List separately in addition to code for primary procedure)
93613 Intracardiac electrophysiologic 3-dimensional mapping (List separately in addition to code for primary procedure)

The following code may be billed with 93656:

93623 Programmed stimulation and pacing after intravenous drug infusion (List separately in addition to code for primary procedure)

If a separate and identifiable non-atrial fibrillation site is ablated, you can report the following code in addition to 93656:

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)

For additional right or left atrial fibrillation that is separate from the original site ablated, you can report the following:

93657 Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (List separately in addition to code for primary procedure)

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