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CodeMap® 12/19/2008: Year End Radiology Wrap-Up CodeMap®-12/19/2008: Year End Radiology Wrap-Up Archive

CodeMap® Radiology Briefing: 12/19/2008


Editor's Welcome

 

Welcome to the final CodeMap® Radiology Briefing of 2008. This week, we will examine the coding and Medicare reimbursement changes that will become effective January 1, 2009. As always please feel free to email any questions, comments, or suggestions. Happy Holidays.

Sincerely,
Gregory Root, Esq.


2009 Radiology Coding & Reimbursement Update

by:  Stacie L. Buck, RHIA, CCS-P, LHRM, RCC, CIC
President/Senior Consultant, RadRx
sbuck@radrx.com

2009 CPT Changes for Radiology

Unlike past years, there are not any major changes to CPT codes in the radiology section of the CPT manual.  Many codes in the diagnostic radiology section have grammatical changes to the code descriptors, but the code descriptors have remained the same. Below is a summary of a few revisions, additions, and deletions to the radiology section of the CPT manual.  Consult your CPT manual for a complete listing of revisions, additions and deletions.    

 

New

78808 Injection procedure for radiopharmaceutical localization by non imaging probe study, intravenous (eg, parathyroid adenoma)

(For sentinel lymph node identification, use 38792)

This procedure is performed during procedures to identify parathyroid tumors or sentinel nodes in patients with breast cancer or melanoma. This code describes the injection of the radiopharmaceutical for purposes of localization.

Deleted

78890 Generation of automated data: interactive process involving nuclear physician and/or allied health professional personnel; simple manipulations and interpretation, not to exceed 30 minutes


78891  Generation of automated data: interactive process involving nuclear physician and/or allied health professional personnel; complex manipulations and interpretation, exceeding 30 minutes

These two codes have been deleted because advances in technology have rendered them obsolete. 

Revised

The descriptor for code 74270 has been revised to read “Radiologic examination, colon; contrast (eg. barium) enema, with or without KUB”.  The  current description reads “Radiologic examination, colon; barium enema, with or without KUB.”  The code was revised to indicate that it is not only to be used for barium enemas, but can be used to report enemas performed with other types of contrast. 

New Parenthetical Notes

72275 Epidurography, RS&I

(For injection procedure, see 62280-62282, 62310-62319, 64479-64484)

This parenthetical note was revised because Category III code 0027T has been deleted. 

76998 Ultrasonic Guidance, intraoperative

(Do not report 76998 in conjunction with 47370-47382, 36475-36479)

This  parenthetical note has been revised to clarify that the endovenous ablation therapy codes (36475-36479) include US guidance.    

77057 Screening mammography, bilateral (2-view film study of each breast)

(Use 77057 in conjunction with 77052 for computer aided detection applied to a screening mammogram)

(For electrical impedance breast scan, use 76499)

This parenthetical note was revised because code 0060T has been deleted.  The cross reference was added to direct the coder to the appropriate code for electrical impedance breast scan. 

77082 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; vertebral fracture assessment

(For dual-energy X-ray absorptiometry (DEXA) body composition study, use 76499)

This parenthetical note was added to direct the coder to the appropriate code for body composition studies.

Reference:  CPT Changes 2009:  An Insider’s View


2009 Reimbursement Changes: Outpatient Prospective Payment System

CMS has established five new imaging composite APCs to encourage imaging efficiencies under the OPPS by providing a single APC payment when two or more imaging procedures using the same imaging modality are provided in a single session. Composite APCs were first introduced for 2008.   

The five new composite APCs are:

  • Ultrasound
  • Computed tomography (CT) and computed tomographic angiography (CTA) without contrast
  • CT and CTA with contrast
  • Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) without contrast
  • MRI and MRA with contrast.

The OPPS conversion factor has increased .6% to $66.059 for 2009, however hospitals that do not meet quality reporting requirements will be paid at a lower conversion factor of $64.784. 

The complete text of the 2009 OPPS Final Rule can be viewed at: http://www.cms.hhs.gov/HospitalOutpatientPPS/HORD/list.asp#TopOfPage


 

2009 Reimbursement Changes: Medicare Physician Fee Schedule

In 2009, CMS expands its multiple imaging procedure reductions by adding ten new procedures to the list of codes subject to the multiple payment reduction:

  • Added to Family 5 MRI and MRA of Head, Brain, Neck:  70336, 70554
  • Added to Family 4 MRI and MRA of Chest, Abdomen & Pelvis:  75557, 75559, 75561, 75563, 77058, 77059
  • Added to Family 1 Ultrasound Chest, Abdomen, Pelvis (Non-OB):  76776, 76870

CMS continues to hold reduction at 25% on second and subsequent procedures.  It has not implemented the 50% reduction that was originally proposed a few years ago. 

The multiple procedure reduction applies to the technical component of imaging services paid under the MPFS which are in 11 designated “families” of procedures. In addition to the multiple procedure reduction, most outpatient imaging services are capped at the OPPS rate of reimbursement.  Services are reimbursed at the lesser of MPFS or OPPS.  If an exam is performed that is subject to both reductions, the 25% reduction will be applied first, the technical component cap (OPPS rate) will be considered second, and then lower of the two amounts will be paid to the provider. 

For 2009 there was an average increase of 1.1% under the MPFS, but the conversion factor was decreased from $38.08 in 2008, to $36.066 for 2009 due to the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).  The MIPPA update supersedes the update that would have resulted from the formula specified in the Medicare law which includes application of the sustainable growth rate (SGR).

The complete text of the 2009 MPFS Final Rule can be viewed at:  http://www.cms.hhs.gov/PhysicianFeeSched/PFSFRN/list.asp#TopOfPage


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12/19/2008: Year End Radiology Wrap-Up
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10/08/2008: 2009 Payment Recommendations
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8/22/08: Recent Subscriber Questions
08/08/2008: New PSA Screening Criteria
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7/17/2008: Medicare Improvements Act
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6/20/2008: Medicare Payment Systems for Lab Tests III
July 2008 NCD Update
6/6/2008: Medicare Payment Systems for Lab Tests II
05/30/2008 Physician Signature Policy for Lab Claims
05/23/2008: Medicare Payment Systems for Lab Tests
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04/11/2008: Subscriber Questions
04/04/2008: Relying on Guidance
03/28/2008: Comparative Effectiveness
03/14/2008: New ABN Form
02/22/08: Standing Orders
02/15/2008: New Metabolic Panels
2/8/2008: Diagnosis Coding Rules for Labs
02/01/2008: Using Unlisted CPT Codes
01/18/2008: Home PT/INR Testing and Monitoring
01/11/2008: Significant Changes to 2008 Physician Fee Schedule
CodeMap Compliance Briefing: 01/03/2008: Annual Compliance Audits
CodeMap Compliance Briefing: 12/14/07: 2008 PFS: New Direct Billing Provisions
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9/14/07: Coding Pap Smears
9/7/07: Date of Service Rules
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CodeMap Compliance Briefing: 8/17/07: Medicare Claims Processing Rules
8/10/07: Procedure Code Modifiers
7/27/07 Billing Medicare for Peripheral Blood Smear Interpretations
7/20/07: 2008 ICD-9 Code Changes
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6/22/07: Excessive Charges to Medicare
6/15/07: Compliance Training
6/08/07: Glucose Testing for Hospital Patients
6/01/07: Reimbursement for Unlited Procedures
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04/20/2007: Medicare Coverage Vocabulary
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03/30/2007: Reimbursement Vocabulary
03/23/07: Compliance Vocabulary
3/16/07: Medically Unlikely Edits (MUE) Implementation
3/2/07: The Physician Quality Reporting Initiative (PQRI)
CodeMap Compliance Briefing: 2/23/07: New Anticoagulant Management Codes
2/09/07: Glycosylated Hemoglobin (A1c) Test Codes
02/02/2007 National Provider Identifiers
CodeMap Compliance Briefing: 1/26/07: The Deficit Reduction Act
CodeMap Compliance Briefing: 1/19/07: The Civil False Claims Act
12/19/06 Medically Unlikely Edits (MUEs)
12/11/06 - 2007 Medicare Laboratory Fee Schedule
CodeMap Compliance Briefing: 12/1/06: Category III Codes
11/17/2006 2007 Radiology CPT Codes
11/10/06 New and Revised CPT Codes for Laboratory and Pathology Procedures
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10/20/06 Dealing with Medicare Overpayments 
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10/6/06: Stark II Issues, Part 1
09/29/2006 Medical Necessity Updates
09/15/06: Medicare Coverage of PSA Testing
9/8/06 Public Consultation on Medicare Payment for Lab Tests
08/25/06: Point of Care Hemoglobin A1c Testing
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08/11/06 CMS Awards First A/B MAC Contract
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7/14/06 Setting Reimbursement Amounts for New 2007 Codes
07/07/06: New 2007 Laboratory CPT Codes
06/09/2006 Competitive Bidding III
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CodeMap Compliance Briefing: 5/5/06: Subscriber Questions
04/28/2006: Billing for Purchased Interpretations
CodeMap Compliance Briefing 4/21/06
03/31/2006: Physician Voluntary Reporting System
03/24/06 Medicare Organization/ Administration
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03/10/06: Automated Test Coding and Reimbursement
02/24/2006 Pay for Performance
02/17/2006: Inherent Reasonableness
2/10/06: Microarray Codes
02/03/2006 Refresher Course: Compliance Programs
01/20/2006 Refesher Course: Medicare Reimbursement
01/13/06: Laboratory Phlebotomists in Physician Offices
CodeMap Compliance Briefing: 1/06/06 2006 Federal Budget
CodeMap Compliance Briefing: 12/16/05: Lipid Codes
CodeMap Compliance Briefing: 12/9/05: Important Year End Dates
12/02/05 Fecal Occult Blood Tests
11/18/05 Employee Compliance Training
11/04/2005 New CPT Codes for Radiology
Compliance Policy Manual
10/21/2005: New CPT Codes for Lab and Pathology
CodeMap Compliance Briefing: 10/14/05: Providing Regulatory Information to Customers
CodeMap Compliance Briefing: 10/07/05: Employee Screening
CodeMap Compliance Briefing: 9/29/05: Waived Testing
CodeMap Compliance Briefing: 09/23/05: Drafting Compliance Policies
09/16/2005 2006 Lab Codes and Proposed Payments
09/09/2005: LIS and Medical Necessity
08/19/2005: Lab Tests on the 2006 Physician Fee Schedule
08/05/2005 Coding Bone Marrow and Bone Biopsies
CodeMap Compliance Briefing 07/22/05: Coding Antibody and Antigen Assays II
07/08/2005 Coding Antibody and Antigen Assays: I
06/24/2005 Resubmitting Denied Medicare Claims
06/17/2005 Diagnosis Coding Rules-Part 2
05/20/05 Diagnosis Coding Rules Part 1
05/13/2005 Reflex Manual WBC Differentials
05/06/2005 Incident To Services
04/29/2005 CMS Manuals
04/22/2005 Reflex Testing
04/15/2005 Custom Panels
04/08/2005 Medicare Administrative Contractors (MACs)
04/01/2005 Place of Service (POS) Codes
03/18/2005 Subscriber Questions
03/11/2005 Medically Unbelieveable Edits
03/04/2005: Final Hospital Compliance Guidance 4
02/25/2005: Final Hospital Compliance Guidance 3
02/18/2005 Final Hospital Compliance Guidance 2
02/11/2005 Final Hospital Compliance Guidance
02/04/2005 Final Diabetes Screening Rules
01/28/2005 Medicare Appeals II
01/21/2005: Medicare Appeals I
01/14/2005 Providing Services to SNFs
01/07/2005 Medicare Errors
12/17/2004 Year End Subscriber Questions
12/10/2004 Coding Flow Cytometry Services
12/08/2004 Alert: 2005 CodeMap Manual Production Schedule
12/03/2004 Diabetes Screening Tests
11/22/2004 Announcing CodeMap Data Files
11/19/2004 Flow Cytometry Coding and Reimbursement
11/12/2004 New Venipuncture Rules
11/05/2004 Medicare Cardiovascular Screening Benefits
10/29/2004 Subscriber Questions
10/22/2004 Genetic Testing Modifiers
10/15/2004 Coding Glucose Tests
10/08/2004 Shared Laboratories
10/01/2004 Stark II and POLs
09/24/2004 New CPT Codes for Pathology Services
09/17/2004 New CPT Codes for Lab Services
08/27/2004 SNF Consolidated Billing Exceptions
08/20/2004 The OIG Exclusion Program
08/13/2004 Medicare Initial Preventive Physical Exam
08/06/2004 New Medicare Coverage for Screening Tests
07/30/2004 Discounts to Financially Needy Patients
07/23/2004 Date of Service for Lab Tests
07/16/2004 New CPT Codes for 2005
06/25/2004 Updates to NCDs and LMRPs
06/18/2004 New Compliance Program Guidance for Hospitals II
06/11/2004 New Compliance Program Guidance for Hospitals II
06/04/2004 Annual Physician Notices
05/21/2004 Screening Pap Smear Coverge
05/14/2004 Transfusion Medicine Codes II
05/07/2004 Transfusion Medicine Codes I
04/23/2004 Anti-Mark-Up Controversy
04/16/2004 Subscriber Questions
04/09/2004 Genetic Testing Codes II
04/02/2004 Genetic Testing Codes I
03/26/2004 Laboratory Marketing Practices III
03/19/2004 Laboratory Marketing Practices II
03/12/2004 Laboratory Marketing Practices I
03/05/2004 Medicare Payment for CLIA Waived Tests
02/27/2004 Medicare Payment for ReferredTests
02/20/2004 Grace Period for CPT Codes Eliminated
02/14/2004 CCI Edits Associated with New Lab and Pathology Codes
02/06/2004 CCI Edits Associated with New Radiology Codes
01/30/2004 Venipunctures
01/23/2004 The Medicare Prescription Drug, Improvement, and Modernization Act of 2003
01/16/2004 Travel Allowances
12/19/2003 Medicare Modernization Act
12/12/2003 Medicare Reform Bill Part 2
12/05/2003 Medicare Reform Bill Part 1
11/21/2003 New HCPCS Codes for CBCs without Platelets
11/07/2003 GA, GY and GZ Modifiers
10/31/2003 Specimen Collection
10/24/2003 Coding Qualitative Drugs-of-Abuse Tests
10/17/2003 The OIG's Work Plan, Medicare CDs, Recent Enforcement Actions.
10/10/2003 ESRD Composite Rate Lab Tests
10/03/2003 End Stage Renal Disease (ESRD) Reimbursement for Automated Tests
09/26/2003 Proposed Rules from the OIG
09/12/2003 Category III (Tracking) CPT Codes
09/05/2003 New Proposed Rules for Flow Cytometry
08/15/2003 Thyroid Testing
08/01/2003 CMS Lab Reimbursement Meeting
07/25/2003 NCD Misconceptions
07/18/2003 The -GZ Modifier
07/11/2003 Screening Mammogram Codes
06/27/2003 Correct Coding Edits II
06/20/2003 Correct Coding Edits I
06/13/2003 Diagnosis Coding Rules II
06/06/2003 Diagnosis Coding Rules I
05/23/2003 Revised Medicare Appeals Provisions II
05/16/2003 Revised Medicare Appeals Provisions I
05/09/2003 Business Associates Agreements
05/02/2003 Pathologist Interpretation of Clinical Lab Tests
04/25/2003 TC Billing of Pathology Services
04/18/2003 Medicare Reimbursement for Pathology Services
04/11/2003 How to Respond to a Search Warrant
03/28/2003 How to Respond to Subpoenas
03/21/2003 How to Respond to Investigators
03/14/2003 Mandatory Claim Submission
03/07/2003: Who Can Order Diagnostic Tests?
02/28/2003 Changes in 2003 Physician Fee Schedule
02/21/2003 Medical Necessity Requirements for Chemistry Panels, Part II
02/14/2003 Medical Necessity Requirements for Chemistry Panels I
02/07/2003: ABNs and Client Cooperation
01/31/2003: Patient Ordered and/or Performed Testing
01/24/2003: The Beneficiary Anti-Kickback Statute
01/17/2003: Significant Changes in 2003 Medicare Reimbursement
01/10/2003: 2003 Medicare Lab and Physician Fee Schedules
12/13/2002: More National Coverage Policies
12/06/2002: How Medicare Sets Fees for New CPT Codes
11/22/2002: Critical Year End Dates
11/15/2002: 2003 Medicare Laboratory Fee Schedule
11/08/2002: Stark Self-Referral Prohibitions
11/01/2002: Using Modifiers -59 and -91
10/25/2002: Introduction to Privacy Regulations
10/18/2002: New Codes for Obstetrical Ultrasound
10/11/2002: National Coverage Determinations (NCDs)
10/04/2002: Implementing a Radiology Compliance Program
09/27/2002: New 2003 Lab CPT Codes
09/20/2002: Automated Order Entry
09/13/2002: National Coverage Policy for Lipids
09/06/2002: The Anti-Kickback Statute
08/23/2002: Using the New ABN Forms
08/16/2002: Advance Beneficiary Notices
08/09/2002: Medicare Coverage for PET Scans
08/02/2002: Reflex Testing
07/26/2002: 2003 Hematology CPT Code Changes II
07/19/2002: 2003 Hematology CPT Code Changes I
07/12/2002: Direct Billing Rules II
06/28/2002: Direct Billing Rules I
06/21/2002: Medicare Reimbursement for Lipid Panels
06/14/2002: Bone Density Studies
06/07/2002: CLIA Waived Testing Rules
05/31/2002: Blood Draws and the Anti-kickback Statute
National Coverage Determination (NCD) Updates
05/01/2002 - CodeMap® Quarterly Reports, Volume I, No. 2
01/15/2002 - CodeMap® Quarterly Reports, Volume I, No. 1