Defining Non-Compounded Sclerotherapy

Transcription

1 Defining Non-Compounded Sclerotherapy December 14, 2017 I m not sure I understand the new vein surgery codes in the 2018 CPT manual. Can you explain what non- compounded means? The new 2018 coded, 36465, describe injection(s) of a non-compounded foam sclerosant into an extremity truncal vein (eg, great saphenous vein, accessory saphenous using ultrasound-guided compression of the junction of the central vein (saphenofemoral junction or saphenopopliteal junction). The sclerosant comes ready to use, it does not need to be compounded (prepared or mixed) by the provider. Note that these new codes also include ultrasound guided compression. Code for ultrasound guidance would not be separately reported The existing sclerotherapy codes, for example, 36470, sclerotherapy injection of sclerosant, single incompetent vein (other than telangiectasia), describe a sclerosant solution that is mixed (compounded ) by the provider prior to injection. The codes for non-compounded ( ) and compounded ( ) sclerotherapy are shown below. CPT Code Description Global Days

2 Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) New in 2018 multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg New in 2018 Injection of sclerosing solution; single vein multiple veins, same leg 10 *Global Days 10 of 12/14/ Binocular Microscopy December 14, 2017 I used the microscope to examine both ears during an office visit because the middle ear Otoscopic exam was abnormal. Can I report with modifier 50 (bilateral procedures)? No. CPT describes using a microscope for an examination

3 it represents payment for using a separate piece of equipment for your exam. The code is not reported twice, nor is modifier 50 appended, when both ears are examined. of 12/14/17. CMS Reimbursement Reduction for CR Technology in 2018 December 1, 2017 My physician read that we will be paid less for radiology services in 2018, and that we need to use a special modifier because we use CR technology. Do you know anything about this? Yes, that is correct. Medicare will institute a 7 percent reduction in reimbursement for the technical component (TC) of x-rays taken using computed radiology (CR) beginning January 1, This reduction will be in place till 2022, and then increase to a 10 percent reduction. Computed radiography technology is defined as cassette-based imaging that utilizes an imaging plate to create the image involved. For reporting, CMS created modifier FY (X- ray taken using computed radiography technology/cassette-based imaging), which should be appended to the X-ray service reported either globally (without any modifiers) e.g FY, or the x-ray

4 code with the TC modifier appended, indicating only the technical component is being reported for reimbursement e.g TC,FY. The technical component of musculoskeletal X-ray codes ranges from 63% to 78% of the global value, so the practice should expect reimbursement from 94.5% to 95.6% of the standard allowable. (100% x 37% for professional portion) + (93% x 63% for technical portion) = 95.6% (100% x 22% for professional portion) + (93% x 78% for technical portion) = 94.5% of 12/01/17. Coding Transforaminal Injections November 30, 2017 How would you report a left lumbar transforaminal epidural injection (Left L5-S1 and left S1) with fluoroscopic guidance? This is reported as for the first lumbar level (L5-S1) and for the additional level (S1). The fluoroscopy is

5 included. of 11/30/17. Complex Closure with a Soft Tissue Tumor Code November 30, 2017 Can I also bill for the complex repair when I ve also excised a soft tissue tumor like a lipoma in the series of codes? Actually CPT says these soft tissue tumor codes include the simple or intermediate repair and a complex repair may be separately reported. That said, Medicare and many other payors will not reimburse the code because they consider it to be a primary closure. of 11/30/17.

6 Cervicocerebral Imaging What s Not Included November 30, 2017 What s not included in the diagnostic cervicocerebral imaging codes and can be reported separately? The diagnostic cervicocerebral imaging codes do not include: Interventional procedures such as angioplasty or embolization Endovascular stent placement Ultrasound guidance for vascular access, e.g., with Selective arterial catheterization outside the carotid and vertebral arteries and branches 3-D rendering, e.g., or Moderate sedation ( ). of 11/30/17.

7 Billing Medicare Patient Admittance November 30, 2017 I was consulted to see a Medicare patient in the emergency room (ER) by the Emergency Department physician. When I arrived, the patient was still in the ER but had been admitted to the hospitalist and was waiting for a bed. Since the patient is Medicare and has been formally admitted you would report CPT codes for this consultation service, even though the patient is physically in the ED. Keep in mind Medicare does not pay for inpatient or outpatient consultations. of 11/30/17. Moderate Sedation Denials. How do we get paid for 99153? November 30, 2017 We are billing the new moderate sedation codes, but are getting denied on the second 15 minutes, Almost all our patients have sedation for more than 15 minutes. What are we

8 doing wrong? You are doing nothing wrong! The codes you are referencing are listed below. Code or are paid without a problem. It s code that is the issue. When Medicare valued these new codes as part of the Medicare Physician Fee Schedule, (or G0500 for GI endoscopy procedures) had an RVU assigned. Code 99153, for the second 15 minutes, (or a minimum of 23 minutes total of sedation) did not have a professional fee value assigned, indicating that Medicare will not pay for these additional minutes. Medicare considers all physician work for moderate sedation to be covered by the single code; (or G0500 for GI endoscopy procedures). Continue to bill per CPT guidelines that allow this second code. Private payors may pay for this code. Write off the Medicare denial. CPT Code x99151 x99152 Ë99153 Description Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient s level of consciousness and physiological status; initial 15 minutes of intra-service time, patient younger than 5 years of age initial 15 minutes of intra-service time, patient age 5 years or older each additional 15 minutes intra-service time (List separately in addition to code for primary service)

9 G0500 Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient s level of consciousness and physiological status; initial 15 minutes of intra-service time, patient age 5 years or older. Report additional time with as appropriate Use only for GI endoscopy procedures for Medicare patients of 11/30/17. Facet Joint Injections How Many Codes Per Injections November 16, 2017 If two injections are performed in a single facet joint, for example, at L3-L4, is coded once or twice? For medial branch blocks (MBB), two nerves innervate a single facet joint. Therefore, two injections at one facet joint is reported with one CPT code, not two.

10 of 11/16/17. Report for ulcer debridement down to the subcutaneous tissue? November 16, 2017 When performing ulcer debridement down to the subcutaneous tissue do we report the service with CPT 97597? No, CPT and are reported for debridement of the epidermis and/or dermis. For ulcer debridement of the subcutaneous tissue you would report for the first 20 sq cm and CPT for each additional 20 sq cm. Make certain documentation contains the sq cm of the debridement. These codes are used when there is no direct closure of the wound at the time of debridement nor is there a plan for closure as the wound will heal by secondary intention. of 11/16/17.