For the Week of August 22, 2016

Are there any regulations that state what needs to be evaluated (structures of the heart) when the definition of cardiac magnetic resonance imaging (MRI) codes 75557–75565 state “morphology”? There is no mention of “complete” or “limited” within the definition.

As you say, since "complete" and "limited" are not part of the code description and are not defined, then complete evaluation is not needed to assign these codes. As with other computed tomography (CT) and MRI codes, imaging enough to get the diagnosis is enough.

In CPT Changes 2008, when these codes were introduced, the example for 75557 stated "cardiac magnetic resonance imaging (MRI) is ordered to assess the right ventricular structure and function." While there was no description of what EXACTLY would be imaged, this tells us that these studies can be done for certain elements alone.

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What codes are used to report infectious antigen detection?

CPT code series 87260–87999 includes method-specific codes to report testing for specific infectious agent antigens. CPT cannot list every infectious organism, and, for this reason, this code series also includes method-specific codes for the testing of organisms that are not otherwise defined in CPT. Two examples of these codes are 87797 and 87798, which are used to report direct and amplified probe techniques. Methods of testing described in this code series include immunoflourescent, EIA, and nucleic acid direct and amplified probe methods.

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Does Medicare cover the hepatitis B vaccine for all Medicare beneficiaries?

No, currently, Medicare covers the hepatitis B vaccine for certain beneficiaries who are at intermediate to high risk for the hepatitis B virus (HBV). These individuals include healthcare professionals who have frequent contact with blood or blood-derived body fluids during routine work, those with end-stage renal disease (ESRD), persons who live in the same household as an HBV carrier, and persons diagnosed with diabetes mellitus. Other situations could qualify a beneficiary as being at intermediate or high risk of contracting HBV.

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Is there a code for the injection of a radiopharmaceutical when no scan is done (or intended)?

There are two such codes:

38792 Injection procedure; radioactive tracer for identification of sentinel node
78808 Injection procedure for radiopharmaceutical localiztaion by non-imaging probe study, intravenous (e.g., parathyroid adenoma)

Assign code 38792 if the injection is for sentinel node localization and 78808 when it is for probe localization of other issues (such as adenoma).

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What services are included in code 94644 and 94645 for continuous inhalation treatment with aerosol medication?

These CPT codes represent hourly charges for delivery of therapy. The initial hour code—94644—will include set-up time, device/supplies and medication. Each additional hour of therapy is represented by CPT code 94645. For less than one hour of treatment, neither code 94644 or 94645 should be reported.

If the service is performed for less than one hour, code 94640 may be reported. This code describes a treatment administered several times a day at short intervals (e.g., 10 minutes), whereas continuous inhalation treatment (94644, 94645) is administered for longer periods and then discontinued. A higher dosage of medication and different equipment are used.

Also note that CPT code 94644 uses the term “first hour,” and not “up to 1 hour.” This restricts its use to only procedures lasting 60 minutes. This also applies to the add-on code 94645.

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What kinds of services are appropriate for a “new technology” APC?

New technology APCs are reserved for comprehensive services or procedures that are truly new and significant enough to warrant having a unique HCPCS code. They are intended to provide payment under the OPPS for complete services or procedures that cannot be appropriately reported by: 1) an existing HCPCS code assigned to a clinical APC or 2) a new HCPCS code that could be appropriately assigned to a clinical APC.

The most important criterion in determining whether a technology is “truly new,” according to the Centers for Medicare & Medicaid Services (CMS), is the inability to describe appropriately the complete service with a current individual HCPCS code or combination of codes.

For more on new technology APCs, see the document at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/newtechapc.pdf.

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