Third Quarter CDM Updates – Effective July 1, 2013

It’s that time again…  Updates to the Charge Description Master (CDM) for the third quarter are already here.  How time flies!

To summarize, there have been new APCs assigned, deletions, revisions to descriptions and status indicator changes. It is crucial that your CDM is updated to reflect the new information and codes available to ensure correct coding and reimbursement. Team education is also crucial, be sure to share the new information with everyone to improve reimbursement potential.

 

HCPCS C1879 Tissue Marker Implantable will be deleted on June 30, 2013 and replaced with new HCPCS code A4680 Tissue Marker Implantable, any type which will be effective July 1, 2013.

New HCPCS and Category III CPT Codes:

HCPCS	CodeDesc	SI	APC	Edit	ActivDate
G0460	Autologous PRP for ulcers	T	00013		20120802

 

HCPCS	CodeDesc	SI	APC
0329T	Mntr io press 24hrs/> uni/bi	E	00000
0330T	Tear film img uni/bi w/i&r	S	00230
0331T	Heart symp image plnr	S	00398
0332T	Heart symp image plnr spect	S	00398
0333T	Visual ep acuity screen auto	E	00000
0334T	Preq stablj sacroiliac joint	T	00208
C9131	In ado-trastuzumab emtansine	G	09131
C9736	Lab ablate uteri fibroid rf	T	09131
K0008	Cstm manual wheelchair/base	Y	00000
K0013	Custom power whlchr base	Y	00000
K0900	Cstm dme other than wheelchr	Y	00000
Q0090	Skyla 13.5mg	E	00000
Q2033	Influenza Vaccine, (Flublock)	L	00000
Q2050	Doxorubicin inj 10mg	K	07046
Q2050	Zoldedrionic acid 1mg	K	01356

Revisions to Code Descriptions:

C9734 Focused ultrasound ablation/therapeutic intervention, other than uterine leiomyomata, with or without magnetic resonance (MR) guidance which was added April 1, 2013 has a revised description effective July 1, 2013.  The new description has been revised to delete the words “or without”.

C9297 this description change is dated back to 4/1/13.  The old description is Omacetazine mepesuccinate and the new description is Omacetaxine mepesuccinate.

72040 had an old description of radiologic examination, spine, cervical; 3 views or less and the new description is Radiologic examination, spine, cervical 2-3 views.

HCPCS	Old Description	New Description
Q0509	Mis sup/ac imp vad nopay med	Mis sup/ac imp VAD nopay med
Q5001	Hospice in patient home	Hospice or home hlth in home
Q5002	Hospice in assisted living	Hospice/home hlth asst lv
Q5009	Hospice care, NOS	Hospice/home hlth, place NOS

The following represent changes to Status Indicators and Edit Assignments that have been made effective back to January 1, 2013.

HCPCS	Short Code Description	Old SI	New SI	Old Edit	New Edit
81500	Onco (ovar) two proteins	A	E	N/A	9
81503	Onco (ovar) five proteins	A	E	N/A	9
81506	Endo assay seven anal	A	E	N/A	9
81508	Ftl cgen abnor two proteins	A	E	N/A	9
81509	Ftl cgen abnor 3 proteins	A	E	N/A	9
81510	Ftl cgen abnor three anal	A	E	N/A	9
81511	Ftl cgen abnor four anal	A	E	N/A	9
81512	Ftl cgen abnor five anal	A	E	N/A	9
90686	Flu vac no prsv 4 val 3 yrs+	E	L	28	N/A

The following codes had an APC or SI change.  Also noted are the edit changes. Effective July 1, 2013

HCPCS	CodeDesc	Old APC	New APC	Old SI	New SI	Old Edit	New Edit
A9700	Echocardiography Contrast			B	N	62	N/A
J3487	Zoledronic acid	09115	00000	K	E	N/A	28
J3488	Reclast injection	00951	00000	K	E	N/A	28
J9002	Doxil injection	07046	00000	K	E	N/A	28
Q4122	Dermacell			K	G
Q4126	Memoderm/derma/tranz/integup	00000	01452	E	K	9	N/A
Q4134	hMatrix	00000	01453	E	K	28	N/A

New APCs:  Effective July 1, 2013

APC	APCDesc	StatusIndicator
01356	Zoldedronic acid 1mg	K
01452	Memoderm/derma/tranz/integup	K
01453	hMatrix	K
09131	In ado-trastuzumab emtansine	G

Deleted APCs:

APC	APCDesc
00951	Reclast injecetion
09115	Zoledronic acid

APC Description Changes:

APC	Old Description	New Description
07046	Doxil injection	Doxorubicin inj 10mg
09297	Omacetazine mepesuccinate	Omacetaxine mepesuccinate

Status Indicator Changes:

APC	Old SI	New SI
01419	K	G

 CPT Code Changes:

The following codes have been added retrospectively to the conditional bilateral list effective January 1, 2013.  When these new codes came out in January 2013 the instruction was that these were unilateral codes and coders were to use once per date of service for each extremity.  As it turns out, CMS has made a change in the outpatient code editor version 14.2.

• 37211 Transcatheter therapy, arterial infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, initial treatment day.
• 37212 Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day.
• 92071 Fitting of contact lens for treatment of ocular surface disease.  Additionally, this same code was removed from the independent bilateral list on the same effective date of January 1, 2013.

New Modifier:

 JE: ESRD facilities to append a new modifier, JE (Administered via Dialysate) to all ESRD claims where drugs and biologicals are furnished to ESRD beneficiaries via the dialysate solution for claims with dates of service on or after July 1, 2013.

Procedure Device Pair Changes: Code pair requirements.  These two codes have been retro activated back for an effective date of January 1, 2013:

• 92920 Percutaneous transluminal coronary angioplasty; single major coronary artery or branch
• C1885 Catheter, transluminal angioplasty, laser

And finally, Skin Substitute Product Changes the following were added to the product list for skin substitutes effective July 1, 2013:

• Q4126  Memoderm, dermaspan, tranzgraft or integuply, per square centimeter
• Q4134 Hmatrix, per square centimeter

Addendum A and B quarterly updates have also been released:

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates.html

Be sure to educate appropriate departments and staff.   That’s all folks…..Happy Coding and CDM updating!

Be sure to visit CMS.gov for additional information!