April 22, 2006

NYSRS HEALTH INSURANCE, COMPENSATION & CAC REPORT 

MEDICARE UPDATE

EXCERPTS FROM EMPIRE MEDICARE

#1

MNB-2006-2, March 2006

New T Codes for CT Angiography

The new T codes for cardiac computed tomography and computed tomography of coronary arteries have replaced CPT code 71275 for dates of service January 1, 2006 and after. Please use the appropriate T code to report services rendered in accordance with Empire Medicare Services current LCD entitled, Multislice or Multidetector Computed Tomographic Angiography of the Chest (New York LCD #L15934 and New Jersey LCD # L15410).

Please note that there is a new policy in draft entitled, Cardiac Computed Tomography and Computed Tomography Coronary Angiography, which describes the T codes more completely. When this policy becomes final, it will replace LCD number L15934 for New York and L15410 for New Jersey.

Reference: Change Request 4057

© All current procedural terminology (CPT) codes and descriptors copyrighted by the American Medical Association.

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#2

The new T codes for cardiac computed tomography and computed tomography of coronary arteries have replaced CPT code 71275 for dates of service January 1, 2006 and after. Please use the appropriate T code to report services rendered in accordance with Empire Medicare Services’ current local coverage determination (LCD) entitled, Multislice or Multidetector Computed Tomographic Angiography of the Chest (New York LCD # L15934 and New Jersey LCD # L15410). The new T codes are:

Please note that there is a new policy in draft entitled, Cardiac Computed Tomography and Computed Tomography Coronary Angiography, which describes the T codes more completely. When this policy becomes final, it will replace LCD #s L15934 for New York and L15410 for New Jersey.

Posted: 03/07/2006

CPT codes, descriptions, and other data only are copyright 2005 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.

OIG Recommends Monitor/Audit for Codes with Modifiers 59 and 25

Because of a high error rate for use of codes with modifiers, -59 and -25, (40% & 35%, respectively), the OIG is recommending additional audits of the use of these modifiers. 

         Regarding Modifier 59, there must be documentation that the, “ . . . procedures you claim are distinct and weren’t performed at the same session, same anatomical site, and/or through the same incision.”  One recommendation to reduce claim rejections is to, “ . . . use separate ICD-9 codes” and, “ . . .append modifier 59 to the second code, rather than the primary service code or both codes.” 

         To avoid rejections for Modifier 25, make:  (1) “ . . . certain that your claim includes E/M services that are significant and separately identifiable.”  These should be, “ . . . above and beyond the usual preoperative and postoperative care associated with the procedure.”; (2) make certain to have “ . . . complete documentation of both the procedure and the separate E/M.”; (3) “Don’t append modifier 25 if an E/M is the only service . . .” provided by the physician for the patient on that day.

                  (Radiology Coding Alert, Volume 8, No. 2, February, 2006, p. 13)

Avoid Abbreviations With Inadequate Coding Information:

Recommendation for referring physicians that use terminology and/or abbreviations that are unacceptable or non-standard for coding:  consider using an order form that allows options with appropriate terminology, e.g. abdomen, pelvis with IV Contrast.  Avoid the use of the word, ‘Protocol’ which has no meaning or relevance for CPT coding.

         (Radiology Coding Alert, Volume 8, No. 3, March, 2006, pp. 17-18)

Anatomical Coverage Specifications for CT of the Abdomen &/or Pelvis

“A typical CT of the abdomen should include transaxial images from the dome of the diaphragm to the iliac crest with up to 10 mm slice thickness. A typical CT

of the pelvis would extend from the iliac crest to the ischial tuberosities with up to 10 mm slice thickness . . . Often, depending on the clinical circumstances, both the abdomen and pelvis must be examined concurrently. An adequate study may be performed with sequential single-slice technique, multislice helical (spiral) technique, or multidetector multislice technique.” --- For additional details, see:

         (ACR Practice Guideline for the Performance of Computed Tomography of the Abdomen or Computed Tomography of the Pelvis)

         (Radiology Coding Alert, Volume 8, No. 3, March, 2006, pp. 18-19)

*For more detailed information, recommend review of the source information, cited above.

Home Page Information:

http://www.ghimedicare.com/

http://www.umd.nycpic.com/

http://www.gao.gov

Coding 

Upstate Medicare - http://www.umd.nycpic.com/billtips.html#ICD-9-CM  and then select, ICD-9-CM Coding for Diagnostic Tests

Respectfully submitted,

Arthur J. Segal, M.D., F.A.C.R.

Chairman, Medical Insurance and Compensation Committee / NYSRS CAC Representative