Sunday, October 4, 2015

New Separately Payable Procedure Code C9743, Can we bill with CPT CODE C9399?

Effective October 1, 2015, a new HCPCS code C9743 has been created. The short descriptor is: Bulking/spacer material impl (NOTE: The short descriptor field is limited to 28-characters, including spaces. This short descriptor is exactly 28 characters.)

The long descriptor is: Injection/implantation of bulking or spacer material (any type) with or without image guidance (not to be used if a more specific code applies). This code is being assigned the ASC Payment Indicator ASC PI) of “G2” (Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight).

Revised 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 andvantibiotics are being used with increased frequency in ocular surgery (primarily cataractvsurgery). One example of combined or compounded drugs includes triamcinolone and oxifloxacin with or without vancomycin. Such combinations may be administered as separate injections or as a single combined injection. Because such injections may obviate the need for post-operative anti-inflammatory and antibiotic eye drops, some have referred to cataract surgery with such injections as “dropless cataract surgery.”

As stated in Chapter VIII, Section D, Item 20 of the CY 2015 “NCCI Policy Manual,” injection of a drug during a cataract extraction procedure or other ophthalmic procedure is not separately reportable. (The “NCCI Policy Manual” is available in the Downloads section at ttps:// on the Centers for Medicare & Medicaid Services (CMS) website.) 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.

According to Chapter 17, Section 90.2, of the “Medicare Claims Processing Manual,” the compounded drug combinations described above and similar drug combinations should be reported with HCPCS code Q9977 (Compounded Drug, Not Otherwise Classified), 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.

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