Thursday, May 14, 2015

CPT code C2624 and C9742

Many ASC payment rates under the ASC payment system are established using payment rate information in the Medicare Physician Fee Schedule (MPFS). The payment files associaated with this transmittal reflect the most recent changes to CY 2015 MPFS payment. Key updates are:

1. New Device Pass- Through Category and Device Offset for Payment

Additional payments may be made to the ASC for covered ancillary services, including certain implantable devices with pass-through status under the outpatient prospective payment system (OPPS). Section 1833 (t) (6) (B) of the Social Security Act (the ACT) requires that, under the OPPS, categories of devices be eligible for transitional pass-through payment for at least 2, but not more than 3 years. Section 1833(t)(6)(B)(ii)(IV) of the Act requires that we create additional categories for transitionalpass-through payment of new medical devices not described by current or expired categories of devices. This policy was implemented in the 2008 revised ASC payment system.

The Centers for Medicare & Medicaid Services (CMS) is establishing one new HCPCS device pass-through category as of January 1, 2015 for the OPPS and the ASC payment systems. That HCPCS code is HCPCS code C2624 (wireless pressure sensor) is assigned ASC PI=J7 (OOPS pass-through device paid separately when provided integral to a surgical procedure on ASC list; payment contractor-priced). Table 1 below shows more details.

Table 1 - New Device Pass - Through Code HCPCS

Table 1
HCPCS Short Descriptor Long Descriptor ASC Payment Indicator (PI)
C2624 Wireless pressure sensor Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components J7

2. New Service
The Centers for Medicare & Medicaid Services (CMS) is establishing one new HCPCS surgical procedure code for ASC use effective January 1, 2015, as shown in table 2.

Table - New Procedure Payable under the ASC Payment System Effective January 1, 2015

HCPCS Short Descriptor Long Descriptor ASC Payment Indicator (PI)
C9742 Laryngoscopy with injection Laryngoscopy, flexible fiberoptic with injection into vocal cord(s), therapeutic, including diagnostic laryngoscopy, if performed G2

3. Billing for Corneal Tissue
CMS reminds ASCs that, according to the "Medicare Claims Processing Manual," Chapter 14, Section 40 - Payment for Ambulatory Surgery, corneal tissue is paid based on acquisition cost or invoice. To receive cost based reimbursement for corneal tissue acquisition, ASCs must bill charges for corneal tissue using HCPCS code V2785.

4. Coding Guidance for Intraocular or Periocular Injections of Combinations of Anti-Inflammatory Drugs and Antibiotics

Intraocular or periocular injections of combinations of anti-inflammatory drugs and antibiotics are being used with increased frequency in ocular surgery (primarily cataract surgery). One example of combined or compounded drugs includes triamcinolone and moxifloxacin with or without vancomycin. Such combinations may be administered as separate injections or as a single combinations may be administered as separate injections or as a single combined injections. Because such injections may obviate the need for post-operative anti-inflammatory and antiboitic eye drops, some have referred to catract surgery with such injections as "dropless cataract surgery".
Specifically, no separate procedure code may be reported for any type of injection during surgery or in the perioperative period. Injections are a part of the ocular surgery and are included as a part of the ocular surgery and the HCPCS code used to report the surgical procedure.
The compounded drug combinations described above and similar drug comb
inations should be reported with HCPCS code J3490 (Unclassified drugs), regardless of the site of service of the surgery, and are packaged as surgical supplies in both the Hospital Outpatient Department (HOPD) and the ASC. Although these drugs are a covered part of the ocular surgery, no separate payment will be made. In addition, these drugs and drug combinations may not be reported with HCPCS code C9399.

The physicians or facilities should not give Advance Beneficiary Notices (ABNs) to beneficiaries for either these drugs or for injection of these drugs because they are fully covered by Medicare. Physicians or facilities are not permitted to charge the patient an extra amount (beyond the standard copayment for the surgical procedure) for these injections or the drugs used in these injections because they are a covered part of the surgical procedure. Also, physicians or facilities cannot circumvent package payment in the HOPD or ASC for these drugs by instructing beneficiaries to purchase and bring these drugs to the facility for administration.

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