#hcpcs codes

Keep your medical coding books handy.

Physician practices have been using the new CPT® and ICD-10 codes for a while now, and many have struggled with the best ways to incorporate them into their practice. In this article we cover some frequently-asked questions (FAQs) relating to 2019 code changes along with answers that can guide your reporting:

Question 1: Our gastroenterologist removed a PEG tube for a patient in the office and did not replace it. We are not sure which code to use here. Should we use the new code 43762?

Answer: No, in this situation, you cannot use the 2019 code 43762 as this code only applies if the gastroenterologist removed the PEG tube and then placed another one. In its place, the best bet for a PEG tube removal in the office is to report the proper outpatient E/M code – 99201-99215 – which you should choose based on the physician’s documentation.

Question 2: How should we report ulcerative blepharitis of the left upper eyelid following the overhaul of blepharitis codes?

Answer: As you know, new codes in 2019 ICD-10 coding books expanded the blepharitis codes to allow you a way to report additional eyelids, when affected. But that does not mean there are new codes for every blepharitis condition.

If the patient has ulcerative blepharitis of the left upper eyelid, you’ll report H01.014 (Ulcerative blepharitis, left upper eyelid). Here you’ll report it the same way as you reported in 2018.

What’s different though is that in the 2019 new code set, you can report just one code when more than one eyelid is affected with blepharitis, contrary to the old way, which requires you to bill multiple codes when you treat multiple eyelids. The new codes include: H01.00A, H01.00B, H01.01A, H01.01B, H01.02A, and H01.02B.

So, make sure you report blepharitis using the “business as usual” approach unless multiple eyelids are affected.

Question 3: Which of the two new ERG codes – 92273 or 92274 – apply to pattern ERG?

Answer: Sadly, neither of these CPT® codes – 92273 or 92274 – represents the right way to report pattern ERG. The fact is CPT® 2019 introduced not two but three codes, and one of them is a Category III code – 0509T – Electroretinography (ERG) with interpretation and report, pattern (PERG). And, that’s why you may have overlooked it.

For your scenario, the appropriate code would be 0509T as your physician performed a pattern ERG. Look up the introductory note to the section of CPT® where these codes are listed …If the technique used is not specifically named in the descriptors of codes 92273, 92274, or 0509T, go for the unlisted code 92499.

Thus, all of your ERG services will not always fit into one of the three codes mentioned above. In some cases, your best bet will be 92499. That’s why it’s very important to read the documentation carefully to confirm the ERG type prior to selecting the correct code.

Question 4: What’s the difference between the new elastography codes for 2019 – 76981 and 76892?

Answer: CPT® 2019 deleted the temporary ultrasound elastography code +0346T and replaced it with a couple of new codes – 76981 and 76982. The difference between the two procedures depends on the type of tissue being examined. So, for example, if you are performing a US elastography procedure on diseased liver tissue, you will select 76981 as the provider is imaging an organ. On the contrary, if the provider performs a US elastography on diseased tissue not affecting a particular internal organ, you would use the code 76982.

Have More Questions? Here’s a Simple Solution

Are you still facing challenges about which of the 2019 codes to use or how the revisions or deletions impact your procedure and diagnosis coding? Even though it’s a costly annual expense, bottom-line is you really should have new versions of CPT®, ICD-10 and HCPCS medical coding books each year.

Best bet:

Four FAQs Help Guide Your 2019 CPT® And ICD-10 Reporting – TCI

Keep your medical coding books handy.

Physician practices have been using the new CPT® and ICD-10 codes for a while now, and many have struggled with the best ways to incorporate them into their practice. In this article we cover some frequently-asked questions (FAQs) relating to 2019 code changes along with answers that can guide your reporting:

Question 1: Our gastroenterologist removed a PEG…

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Are You Correctly Handling These New HCPCS Q Codes?

You’re probably just getting comfortable with your 2018 edition of HCPCS level II code book, but you’ll have to make a few additional changes to your reporting. CMS has released five new HCPCS Level II codes, effective July 1, 2018. All the new codes are Q codes (assigned on a temporary basis) that will be used to designate treatments for knee pain, opioid addiction, cystic fibrosis, and hemophilia.

Read on to be sure you’re on top of the latest the HCPCS codes 2018 changes.

Welcome Two New Codes for Sublocade

You now have a set of two related codes for Sublocade (a drug used for treatment of moderate to severe opioid use disorder in adult patients) – Q9991 (less than or equal to 100 mg) and Q9992 (greater than 100 mg).

To distinguish the two codes, watch the mg. The diagnosis codes connected to these codes will be in the F11.2 – (Opioid dependence) subcategory. Some payers are expanding that list to subcategories like F11.1- (Opioid abuse) and F11.9- (Opioid use, unspecified). Find out if your payer has any specific policy for Sublocade. The Medicare coverage status for these codes are C.

Note New Code for Zilretta

You’ll report Zilretta (drug for injection into osteoarthritic knees) with new Q code Q9993 (1 mg) even though there is no drug name mentioned in the code’s descriptor. The diagnosis codes linked to this code will be under M17.-. The coverage indicator for Q9993 will be D.

Refer This New Code for Relizorb

Q9994 is added to the HCPCS Level II code set effective July 1. You’ll report Relizorb (a drug that helps break down fat in enteral tube formula prior to patient ingestion) with the new code. The coverage indicator for this code will be 1 and will not be payable by Medicare.

Add This New Q Code for Hemlibra

Finally, you’ll report Hemlibra (a drug given to patients with hemophilia) with the new code – Q9995 (Injection, emicizumab-kxwh, 0.5 mg). The diagnosis code associated with this medication is D66 and coverage indicator will be C. Make sure you look up specific payer policies for coverage information.

Ensure Proper Pay for These Services

Reduction in Payment for New Off Campus Provider-Based Clinics. 

If you work for providers offering services in clinics, provider-based or hospital-based off-campus, these newly-introduced and revised POS modifiers could play a key role in the claims process. Section 603 of the Bipartisan Budget Act of 2015 mentions a reduction in reimbursement for ‘new’ off campus provider-based clinics, and this has taken the hospital community by surprise. 

Are you in Sync with the Latest HCPCS Level II codes and Modifiers? 

You will use the PO HCPCS modifier with every code for outpatient hospital services provided in an off-campus PBD of a hospital. The reporting of this new modifier has become mandatory effective January 1, 2016. 

Note: This modifier cannot be used for remote locations of a hospital/satellite facilities of a hospital/services for services provided in ED. 

Updates to POS 19 & 22 

Providers can heed this. The existing POS code set introduces new POS code 19 for Off Campus Outpatient Hospital and revises POS code 22 language to ‘On Campus Outpatient Hospital (previously ‘Outpatient Hospital’). Both these indicators will affect the SOS differential in RBRVS that will lead to decrease in physician, professional payment. Local contractors will create policies as required to adjudicate claims containing new POS code 19 and revised POS code 22 as per Medicare national policy, and treat both the modifiers in the same way. Moreover, the three-day payment window applies to services billed with POS code 19 as well. 

Collect Provider-Based Clinic Data, Says CMS 

The Centers for Medicare and Medicaid (CMS) also wants to start gathering data relative to these clinics, and most likely, other off-campus provider-based operations. Note that hospitals also have provider-based clinics on-campus and often inside the hospital. The agency is keen on finding out whether such provider-based operations are more expensive as compared to their freestanding counterparts. This is because OIG has always emphasized that payments for provider-based clinics and freestanding clinics should be equivalent. What’s more, MedPAC has also pointed out that reimbursement should be same for E/M codes. 

Note that CMS is collecting information on provider-based clinics supposedly because of the pressure coming in from OIG and MedPAC.