Keep Your Cool with July’s Coding and Billing Challenges

HCPCS Level II codesJuly is a busy month for medical coders and billers because so many CPT and HCPCS Level II codes changes are implemented July 1. It’s hard to keep track of all the changes, but it’s essential that you do to ensure your coding/billing is correct. Here are several coding and policy updates you will need to know about to code/bill claims correctly the remainder of the year.

New Medicare Regulations And Guidance

The Centers for Medicare & Medicaid Services (CMS) released many communications to payers and providers that go into effect this month. Here’s a summary of the most relevant transmittals:

  • The July quarterly update of the Ambulatory Surgical Center Payment System (ASC PS) includes five new CPT Category III codes in the ASC PS, one of which replaces a deleted HCPCS Level II codes; a link to updated payment rates effective July 1, 2019; and 10 new separately payable drug and biological HCPCS Level II codes, one code descriptor change, and one payment indicator revision for a CPT code. See MLN Matters article MM11328 for details.
  • July quarterly updates are also in effect for:
    • Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule (MM11334)
    • Integrated Outpatient Code Editor (I/OCE) Specifications v.20.2 (MM11298)
    • Clinical Laboratory Fee Schedule and Laboratory Services subject to reasonable charge payment (MM11280)
    • HCPCS Drug/Biological code changes (MM11296)
    • Hospital Outpatient Prospective Payment System (OPPS) (MM11318)
    • Medicare Physician Fee Schedule Database (MPFSDB) (MM11293)
    • End-stage Renal Disease (ESRD) PPS (MM11215)
  • The Secretary of the Department of Health and Human Services (HHS) declared a Public Health Emergency in Louisiana on July 12, 2019, and CMS issued blanket waivers and modifications to various Medicare policies retroactive to July 10, 2019, which are in effect for 90 days. See MLN Matters special edition article SE19014 for details.
  • Changes in policy of documentation for teaching physicians providing evaluation and management (E/M) services went into effect Jan. 1, 2019, but the implementation date is July 29, 2019. See MLN Matters article MM11171 for details.
  • CMS Transmittal CR11061 sunsets the requirement for independent labs to use the HCPCS Level II modifier CB Consolidated billing to bill separately for renal dialysis lab tests. See MLN Matters article MM11061 for details.
  • MLN Matters article MM11087 explains a change in the way Medicare Administrative Contractors (MACs) deduct organ acquisition charges billed with revenue codes 081X, excluding 0815 and 0819, from the total covered charges prior to sending an inpatient Type of Bill 11X claim to the Inpatient Prospective Payment System (OPPS) pricer for any date of service processed on or after July 1, 2019.
  • Effective July 1, 2019, Medicare will allow modifiers 59, XE, XS, XP, or XU on column one and column two codes to bypass National Correct Coding Initiative (NCCI) procedure-to-procedure edits. See MLN Matters article MM11168 for details.

Check out these CMS communications for complete guidance to ensure you are up to date on your Medicare Part B policy changes for July.

Local Coverage Changes In July

Also check your Medicare Administrative Contractor’s (MAC’s) website (or the Medicare Coverage Database) for updates to local coverage determinations (LCDs) resulting from quarterly code updates. Novitas Solutions, for example, has revised several LCDs, including Hemophilia Factor Products (A56433). As a result of the quarter 3 code update, HCPCS Level II codes C9141 Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl (jivi), 1 i.u. is deleted and J7208 Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u. is added to the Group 3 codes.

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