For the Week of November 23, 2015

How are HCV adult screening tests performed in the hospital outpatient department paid under Medicare? 

In a transmittal issued on November 5, 2015, the Centers for Medicare & Medicaid Services (CMS) added type of bill (TOB) 014x (hospital other Part B) as an applicable TOB for the screening of HCV when submitted for a non-patient laboratory specimen (HCPCS Code G0472). CMS will implement this change on April 4, 2016 but it will be effective for dates of service on or after June 2, 2014. Payment for these services will be based on the laboratory fee schedule. For this transmittal, go to

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If a cardiologist documents acute myocardial infarction (AMI) in the history, and a stent was placed into the left main artery, can we report the code below? 

92941   Percutaneous transluminal revascularization of acute total/subtotal occlusion during AMI, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel

No. The report should document that the patient has an AMI and that the intervention was done on an urgent basis. Without that information, the coder would not know if this was an emergent intervention or if the patient was stabilized with the intervention being performed at a different time.

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How do we determine the units of a drug administration to report on a claim?

The administration dose requested by the physician or other prescribing provider determines the unit of service (UOS) reported on the claim. The pharmacy prepares and dispenses the drug based upon this request. 

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Would it be a contrast-only MRI/MRA scan if localizer scans only are done pre-contrast and most of the diagnostic imaging is done only after contrast administration? In other words, would a non-contrast followed by contrast scan code only apply if additional imaging beyond localizers was done after contrast? 

According to ACR Coding Source (July/August 2015), it is not appropriate to report a non-contrast study of any type (CT or MR) based on localizer images only. MRI always involves “localizer” scans to prescribe any scans, contrast or not. Counting the localizer noncontrast images as sufficient for coding purposes as a noncontrast portion of a "without and with contrast" exam would be inappropriate in the absence of diagnostic sequences performed prior to contrast administration. Specifically, the localizer images are not meant to be used as a non-contrast portion of the examination and should not be coded as such.  

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What is included in code 94002 for ventilation management? 

According to a new entry in the National Correct Coding Initiative Manual that takes effect on January 1, 2016, practitioner ventilation management (e.g., CPT codes 94002–94005, 94660, 94662) and critical care (e.g., CPT codes 99291, 99292, 99466–99486) include respiratory flow volume loop (CPT code 94375), breathing response to carbon dioxide (CPT code 94400), and breathing response to hypoxia (CPT code 94450) testing if performed.

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Are full signatures required on changes to medical record documentation or are initials allowed?

Medicare administrative contractors (MACs) can now accept initials instead of signatures for amendments or delayed entries in medical record entries, if there is evidence in the medical record associating the provider's initials with his or her name. For this information, go to 

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