NYSRS Medical Insurance and Compensation Committee Report
April 17, 2004
Arthur J. Segal, M.D., F.A.C.R., Chairman
MEDICARE UPDATE
Physician Supervision Rules:
“If you are one of the few radiology practices that use nonphysician practitioners, be aware the CMS has recently reversed earlier stances allowing them to supervise diagnostic tests. Most recently it’s said, “Nurse practitioners, clinical nurse specialists, and physician assistants are not defined as physicians under x1861(r) of the [Social Security] Act. Therefore, they may not function as supervisory physicians” for the diagnostic tests [Medicare Benefit Policy Manual [Chap. 15, Sec. 80, formerly MCM 2070}]”
-----Radiology Coder’s Pink Sheet, Vol.3, No 4, April, 2004, p6-7
Congress approves - Medicare Prescription Drug & Improvement Act- +1.5%
On November 25, 2003, Congress approved the Medicare Prescription Drug and Improvement Act effectively raising the conversion factor 1.5% for both 2004 & 2005 despite the original plan to decrease the conversion factor by 4.5%. This takes the conversion rate of 36.7856 in 2003 and increases it to about 37.3373 in 2004.
-----Radiology Coding Alert, Vol.6, No 1, Jan, 2004, p5
Code Exam Payment Before Change New 2004 Payment Percent Increase*
71010 Chest $26.00 $27.63 6.3%
71020 Chest $33.73 $35.84 6.3%
*This is only a 1.5% change compared to the 2003 reimbursement rate
-----Part B News, Vol.18, No 2, January. 12, 2004, p6
Indications for the Use of CPT 71035 – Chest X-Ray:
Since “. . . “a single-view chest (71010) is bundled into the two-view chest (71020) . . .,” you should only add code 71035 when there is a concurrent approved indication for an (1) apical lordotic view, (2) oblique views of the chest, (3) decubitus films for the detection of mobile pleural effusions.
-----Radiology Coder’s Pink Sheet, Vol.3, No 2, Feb. 2004, p3
MRI/MRA
Approved Indications for MRI & MRA – Same Day:
Some of the approved locations for MRI & MRA (and associated ICD-9 codes) on the same date of service include:
MRA of the chest –995.2, 414.1x, 415.11, 441.2, 441.7
MRA of the abdomen – 441.0-441.9
MRA of the peripheral arteries of the lower extremities – 444.22, V45.81
MRA of the head437.3, 447.0, 433.10
MRA of the neck – 433.1x
See your coding manual or this reference for more specifics:
-----Radiology Coder’s Pink Sheet, Vol.3, No 2, Feb. 2004, p6-7
MR ARTHROGRAPHY CODES:
When MR arthrography is performed using fluoroscopically-guided needle placement, the following two codes (injection and MRI) can be used in combination with the code for fluoroscopic needle placement (CPT 76003):
Injection Code MRI Code
Shoulder 23350 73222
Knee 27370 73721
See reference for codes that can be used for other joint arthrography.
-----Radiology Coder’s Pink Sheet, Vol.3, No 4, April, 2004, p3
ULTRASOUND
OB Ultrasound Codes:
CPT 76811 & 76812 – “include all elements of codes 76805 and 76810, plus detailed anatomic evaluation of the fetal brain/ventricles, face, heart/outflow tracts and chest anatomy, abdominal organ specific anatomy, number/length/architecture of limbs and detailed evaluation of the umbilical cord and placenta and other fetal anatomy as clinically indicated.”
CPT 76801 – Ultrasound of the pregnant uterus, real time with image documentation, fetal & maternal evaluation, first trimester (<14 weeks, 0 days), transabdominal approach; single or first gestation) . . .”
CPT 76810 - add once for each additional gestation.
CPT 76815 – limited exam
CPT 76816 – detailed description for follow-up study
CPT 76817 – ultrasound, pregnant uterus, real time with image documentation, transvaginal – for endovaginal exams of pregnant women.
-----Radiology Coder’s Pink Sheet, Vol.3, No 4, April, 2004, p1-3
Avoid Abdominal Ultrasound Denials:
Make certain that “ . . . documentation reflects imaging of ALL of the required organs . . . “
CPT 76700 should be used for “complete abdominal ultrasound” examination and the exam should include “. . . imaging of the diaphragm to the level of the umbilicus, the liver, spleen, gallbladder, common duct, pancreas, hollow upper abdominal viscera and should include an interpretation of the findings.”
CPT 76705 should be used to indicate a limited service, i.e. anything less than described for 76700.
Repeat of New Codes for CPT 2004*:
75998 – Fluoroscopic guidance for central venous access device placement/removal
76937 – Ultrasound guidance for vascular access requiring ultrasound evaluation
72270 – Myelography – two or more regions – represents “descriptor change”
76085 – Deleted mammography code
76082 - Mammography – Computer-aided detection in assoc with diagnostic exam
76083 - Mammography – Computer-aided detection in assoc with screening exam
79403 – Zevalin and Bexxar therapy
78804 – In addition to above 79403, use this for “Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent[s]; whole body, requiring two or more days imaging.
Additional codes that have been updated include: insertion of non-tunneled and tunneled centrally-inserted and peripherally-inserted catheters,
* Review details in official coding manual before using these codes
-----Radiology Coding Alert, Vol.5, No 11, Nov, 2003, p81-83
-----Radiology Coder’s Pink Sheet, Vol.2, No 11 , Nov, 2003, p6
Home Page Information:
Coding
Upstate Medicare -
http://www.umd.nycpic.com/billtips.html#ICD-9-CM
and then select, ICD-9-CM Coding for Diagnostic Tests
Empire - http://www.empiremedicare.com/benenews/brf01-11/fro.htm
Respectfully submitted,
Arthur J. Segal, M.D., F.A.C.R.
Chairman, Medical Insurance and Compensation Committee
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