For the Week of March 20, 2017

Can we bill the following injection codes for drug administration during a cardiac catheterization procedure?
96373      Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intra-arterial
96374      Intravenous push, single or initial substance/drug

Current correct coding initiative (CCI) edits indicate that these codes are a component of the cardiac catheterization and coronary interventional codes and, therefore, should not be billed separately.

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What is the difference between a presumptive lab test and a definitive lab test?

Presumptive tests are used to identify possible use or non-use of a drug or drug class (i.e., the presence or absence of a drug in a urine sample). Qualitative or quantitative methods that identify possible drug use or non-use and identify the specific drugs and associated metabolites are definitive tests.

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Does Medicare cover the IVIG drug Bivigam?

Coverage of BIVIGAM®—immune globulin intravenous (human), 10% liquid—is subject to local coverage determinations (LCDs) issued by regional Medicare Part B carriers and Medicare Administrative Contractors (MACs).

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I have been assigning the following codes for contrast-enhanced liver ultrasound:
76705       Ultrasound, abdominal, real time with image documentation; limited (e.g., single organ, quadrant, follow-up)
Q9950      Injection, perflexane lipid microspheres, per ml
However, I was just told that I should be reporting C9744 (ultrasound, abdominal, with contrast) instead. Is this correct?

The answer depends on whether you are billing for an outpatient hospital department, an imaging center, or a physician. The Centers for Medicare & Medicaid Services (CMS) added code C9744 in October 2016 for outpatient hospital billing of contrast-enhanced abdominal ultrasound. If you are billing for the hospital, you would report C9744 and Q9950 (injection, sulfur hexafluoride lipid microspheres, per ml) for LUMASON® (sulfur hexafluoride lipid-type A microspheres) for injectable suspension, for intravenous use or intravesical use.

However, only outpatient hospital departments billing under OPPS should bill the C-codes. If you are billing for a physician or a non-hospital imaging center, you would continue to report code 76705 (ultrasound, abdominal, real time with image documentation; limited [e.g., single organ, quadrant, follow-up]) along with Q9950.

LUMASON® (sulfur hexafluoride lipid-type A microspheres) for injectable suspension, for intravenous use or intravesical use

INDICATIONS AND USAGE1

LUMASON is an ultrasound contrast agent indicated for use:
• in echocardiography to opacify the left ventricular chamber and to improve the delineation of the left ventricular endocardial border in adult patients with suboptimal echocardiograms
• in ultrasonography of the liver for characterization of focal liver lesions in adult and pediatric patients
• in ultrasonography of the urinary tract for the evaluation of suspected or known vesicoureteral reflux in pediatric patients

CONTRAINDICATIONS1
LUMASON is contraindicated in patients with:
• history of hypersensitivity reactions to sulfur hexafluoride lipid microsphere components or to any of the inactive ingredients in LUMASON

IMPORTANT SAFETY INFORMATION1

WARNING: SERIOUS CARDIOPULMONARY REACTIONS

Serious cardiopulmonary reactions, including fatalities, have occurred uncommonly during or following the injection of ultrasound contrast agents, including sulfur hexafluoride lipid microspheres [see Warnings and Precautions (5.1)]. Most serious reactions occur within 30 minutes of administration [see Warnings and Precautions (5.1)].

• Assess all patients for the presence of any condition that precludes administration [see Contraindications (4)].
• Always have resuscitation equipment and trained personnel readily available [see Warnings and Precautions (5.1)].

The risk for serious cardiopulmonary reactions may be increased among patients with unstable cardiopulmonary conditions (acute myocardial infarction, acute coronary artery syndromes, worsening or unstable congestive heart failure, or serious ventricular arrhythmias) [see Warnings and Precautions (5.1)].1

Please see full Prescribing Information including boxed WARNING by clicking here.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

LUMASON is manufactured for Bracco Diagnostics Inc., Monroe Township, NJ 08831 by Bracco Suisse S.A., Plan-les-Ouates Geneve, Switzerland (LUMASON lyophilized powder vial-25 mg lipid-type A/60.7 sulfur hexafluoride gas); Vetter Pharma-Fertigung GmbH & Co. KG, 88212 Ravensburg, Germany (Sodium Chloride 0.9% Injection, USP); B. Braun Melsungen AG, 34212 Melsungen, Germany (Mini-Spike).

LUMASON is a registered trademark of Bracco Diagnostics Inc.

1. LUMASON (sulfur hexafluoride lipid-type A microspheres) for injectable suspension, for intravenous use or intravesical use full Prescribing Information. Monroe Twp., NJ: Bracco Diagnostics Inc.; December 2016.

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Does Medicare have any guidance for assigning modifier QF (prescribed amount of oxygen is greater than 4 LPM and portable oxygen is prescribed)?

If portable oxygen is prescribed, the fee schedule amount for portable equipment is added to the fee schedule amount for stationary oxygen rental. In addition to modifier QF, modifier QG (prescribed amount of oxygen is greater than 4 LPM) should be used to denote when the oxygen flow exceeds 4 liters per minute.

According to the Centers for Medicare & Medicaid Services in MM9848, modifier QF should be used in conjunction with claims submitted for stationary oxygen (codes E0424, E0439, E1390, or E1391) and portable oxygen (codes E0431, E0433, E0434, E1392, or K0738) when the prescribed amount of oxygen is greater than 4 LPM.

For more on this policy, go to https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9848.pdf.

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What is the purpose of the Medicare CERT program?

The Comprehensive Error Rate Testing (CERT) Program estimates improper payments in the Medicare fee-for-service (FFS) program. CERT reviewers evaluate a random sample of all Medicare FFS claims to determine if they met Medicare coverage, coding, and billing rules. Once the CERT Program identifies a claim as part of the sample, it requests the associated medical records and other pertinent documentation from the provider or supplier who submitted the claim. Medical review professionals check the submitted documentation to see if the claim was paid or denied appropriately.

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