For the Week of January 23, 2017

Do the changes to the moderate sedation guidelines mean that my doctor can now bill for this when he provides it during a transesophageal echocardiogram (TEE)?

Yes. Moderate (conscious) sedation (MS) is no longer bundled into procedures. All of the procedures that have previously included MS have been deleted from Addendum G in the CPT book. If your doctor provides MS while performing a TEE, he or she may separately report it.

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Which Pap Test codes are included in the Medicare national payment rate?

As required by law, payment for a cervical or vaginal smear test (Pap smear) must be the lesser of the local fee or the national limitation amount (NLA) but not less than a national +minimum payment amount, which for 2017 is $14.49. Payment for these tests may not exceed the actual charge.

The national minimum payment amount applies to the following codes: 88142, 88143, 88147, 88148, 88150, 88152, 88153, 88154, 88164, 88165, 88166, 88167, 88174, 88175, G0123, G0143, G0144, G0145, G0147, G0148, G0476, and P3000.

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Are there NDCs for compounded drug preparations?

A compounded drug preparation does not have a national drug code (NDC); therefore, specific HCPCS codes cannot be used, and these drugs are coded as unclassified. Substances primarily used as stabilizing agents, which are inert ingredients or diluents used in the compounded drug, are considered incidental to the preparation of the compound and are NOT eligible for reimbursement.

HCPCS code J7999—compounded drug, not otherwise classified (NOC)— replaced HCPCS code Q9977 on January 1, 2016. Several Medicare contractors have published information on their individual websites about it, and commercial payers may or may not adopt this code. Be sure to follow-up with your specific payers for their billing requirements.

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When will CMS start accepting the new mammography codes?

In the final 2017 Medicare Physician Fee Schedule (PFS) rule, the Centers for Medicare & Medicaid Services (CMS) announced a change in regard to its acceptance of new CPT codes 77065 (diagnostic, unilateral, including CAD when performed), 77066 (diagnostic, bilateral, including CAD when performed), and 77067 (screening, bilateral including CAD when performed).

Although it said, in the proposed rule, that it would accept these codes, CMS will not implement these new codes until January 1, 2018. The reason is that it has identified Medicare claims system processing issues that will prevent such implementation. It will, however, accept existing codes G0202, G0204 and G0206 for those services. The descriptions for these G codes will be changed to delete the term “digital” and to include CAD when performed. They should be reported for both analog and digital mammography for Medicare beneficiaries.

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Did CMS make any changes to the APCs for endoscopies in the 2017 OPPS?


In the 2016 outpatient prospective payment system (OPPS) final rule, the Centers for Medicare & Medicaid Services (CMS) issued five new APCs for airway endoscopies, which continue in 2017. APCs 5151–5155 cover the five levels, which range in price from $146.14 for level 1 to $4,361.11 for level 5. The price of the specific codes can be found in the OPPS Addendum B at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates.html.

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When does the new observation notice take effect, and where can I find it?

The finalized, Office of Management and Budget-approved Medicare Outpatient Observation Notice (MOON) form and instructions are now available at the following website: https://www.cms.gov/Medicare/Medicare-General-Information/BNI/index.html?redirect=/bni. Hospitals and critical access hospitals must begin using the MOON no later than March 8, 2017.

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