Flu Vaccine Update
The Centers for Disease Control and Prevention’s (CDC) Flu Vaccine Update recommends that clinicians continue vaccination efforts as long as flu viruses are circulating.
As of Feb. 3, approximately 145 million doses of influenza vaccine had been distributed in the United States — enough to vaccinate nearly half of the U.S. population. According to the Centers for Disease Control and Prevention’s (CDC) Feb. 17 Morbidity and Mortality Weekly Report, as of Feb. 10, however, influenza activity remained elevated nationally and was widespread across most of the United States.
Coding Pelvic Fracture
The 2017 CPT® codebook features some important changes for coding pelvic ring fractures, including the deletion of two codes, the addition of two new codes, and an added parenthetical instruction.
New Codes for Mammography
There are three New Codes for Mammography introduced in the 2017 CPT code book to better describe the types of mammography services that are now provided;
Hospitals must provide MOON
Hospitals and critical access hospitals (CAHs) must provide the Medicare Outpatient Observation Notice (MOON), or CMS-10611, to patients with Original Medicare who are receiving outpatient observation services for more than 24 hours, effective Feb. 21, 2017. The purpose of this change request (CR) is to update Chapter 30 of Pub. 100-04 to include the Medicare Outpatient Observation Notice (MOON), CMS-10611, form instructions.
AMA Vaccination Codes
AMA Vaccination Codes 2017 CPT® introduces one new vaccine code, and revises the reporting criteria for nine others.
Code 90674 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use is added to improve reporting of quadrivalent vaccine (e.g., Flucelvax®). Quadrivalent vaccines contain two Influenza A strains and two Influenza B strains that the World Health Organization predicted to be prevalent during the current flu season. Note that the descriptor identifies the dosage as 0.5 mL, by intramuscular injection.
New Add-on EM Visit Code
The Centers for Medicare & Medicaid Services (CMS) proposed a new add-on EM visit code G0501 that could be billed with new and established patient office/outpatient Evaluation and Management codes (99201-99205 and 99212-99215), as well as transitional care management codes (99495, 99496), when the additional resources described by the code are medically necessary and used in the provision of care, effective January 1, 2017.
Chapter J of the ICD-10-CM coding manual contains the diagnosis codes for coding tonsillitis. The tonsils are part of the lymphatic and immunologic system. They are the body’s first line of defense and are similar to lymph nodes located in the neck, groin, and armpits.
The tonsils are oval shaped, pink structures in the back of the throat and act as filters by trapping germs that pass through the nose and mouth. They also produce antibodies that help fight infection. Tonsillitis may be either viral or bacterial. Streptococcus pyogenes, the bacteria that causes strep throat, is a common bacterial cause, accounting for approximately 30 percent of tonsillitis in children and 10 percent in adults. Other causes include adenovirus, influenza virus, and Epstein-Barr virus.
OPPS Hospital Claim Issues by CMS
OPPS Hospital Claim Issues have been identified by CMS due to errors in the Medicare Claims Processing System, some Outpatient Prospective Payment System (OPPS) hospital claims with dates of service on or after January 1, 2017, may have been overpaid.
Claims with the following CPT® codes may be affected:
0253T, 0335T, 24361, 25420, 25444, 25445, 27442, 27871, 28715, 28730, 37229, 43266, 45389, 62360, 64580, 69717, and 75898.
In addition, eight Comprehensive Ambulatory Payment Classification (APC) Complexity Adjustment pairs were incorrectly omitted from the claims processing system:
Primary Code Code 2 Complexity-Adjusted APC
28300 27698 5115
28300 28306 5115
33208 C9600 5224
36902 36908 5193
36903 36908 5194
36904 36908 5193
36905 36908 5194
49653 49650 5362
A correction for these issues will be implemented on April 3, reports the Centers for Medicare & Medicaid Services (CMS) in the January 19, 2017, MLN Connects. Medicare administrative contractors will automatically reprocess impacted claims; providers do not need to take any action.
NCCI Edits for Institutional and Physician Claims
National Correct Coding Initiative (NCCI) edit updates for institutional claims have regularly been implemented one quarter behind the physician claim NCCI edits due to systems issues. As a result, some physician single-quarter-only edits were not implemented for institutional claims. Starting April 3, CMS will apply the same physician NCCI edits to institutional claims, including the single-quarter-only edits.
Coding Hearing Loss
Coding hearing loss can be difficult to narrow down depending upon the system damaged and factors involved. Hearing loss is a very common problem caused by factors such as noise, aging, disease, and heredity.
According to the American Speech-Language-Hearing Association, hearing loss can be categorized by which part of the auditory system is damaged.
DRG issues caught by the eye of OIG
The Office of Inspector General (OIG) is reviewing Medicare’s billing and reimbursement integrity for two diagnosis-related groups (DRG) or DRG issues, 1) inpatient claims for kwashiorkor diagnosis, 2) mechanical ventilation in the 2017 Work Plan.