Coding Resource Center
November 2019
November 21, 2019 – In response to the CMS Change Request 10901, Novitas Solutions, Inc. has revised the Local Coverage Article (A53124) for billing and coding of endovascular repair of aortic and/or iliac aneurysms. This document specifies the CPT® codes included for TEVAR, EVAR and separately reportable services performed during the aneurysm repair; and coding […]
November 2019
The OPPS rate is a national unadjusted payment amount which include the Medicare and beneficiary payment. It is divided into a labor-related and nonlabor-related amount, and the labor-related amount is adjusted based on the locality in which the hospital is located. For CY 2020 CMS is: Updating OPPS payment rates for hospitals that meet applicable […]
November 1, 2019 – the Centers for Medicare and Medicaid Services (CMS) issued the final rule for the Medicare Physician Fee Schedule (MFPS), Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgery Center (ASC). Highlights are described below. For MFPS: RVUs are converted to dollar amounts through the application of the conversion factor (CF). The […]
October 2019
October 25 – the AMA CPT® Editorial Panel released the September Meeting summary notes. The following are a few of the changes noted. The full summary can be found at https://www.ama-assn.org/system/files/2019-10/september-2019-summary-panel-actions.pdf. Of interest is the accepted parenthetical note revision in the EVAR section of the CPT® manual following code 34709 (Placement of extension prosthesis(es) distal to the common iliac […]
October 2019
October 17, 2019 – In response to the CMS Change Request 10901, Novitas Solutions, Inc. has revised the LCD (L35084) for Non-Coronary Vascular Stents. The entire coding section of the LCD has been removed and placed into a related Local Coverage Article (A56365). This document specifies the CPT® codes included, and the ICD-10-CM codes that […]
October 2019
On July 29, 2019, CMS issued a proposed rule that would update payment policies and rates under the End Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services effective January 1, 2020. The ESRD PPS provides a patient-level and facility-level adjusted per treatment payment to the ESRD facilities for dialysis services, whether done in the facility or the […]
October 2019
Aetna recently reviewed and revised its policy, number 0651, Endovascular Repair of Aortic Aneurysms for medical necessity. The policy states: Endovascular repair of infra-renal abdominal aortic or aorto-iliac aneurysms with an FDA-approved fenestrated, branched or nonfenestrated endovascular stent graft medically necessary. Endovascular repair of descending thoracic aortic aneurysms with an FDA-approved endoprosthesis medically necessary. Of interest is […]
August 2019
In May 2019, Gore announced FDA approval of the TAG® Conformable Thoracic Stent Graft with active control system for treatment of aneurysms, transections and type B dissections of the descending thoracic aorta. Although no changes were made to the endograft itself, the active control system delivers a two-stage deployment that allows for added precision in […]
August 2019
Reimbursement for dialysis care has been under scrutiny by CMS for some time. Specifically, in 2017 CMS created new bundled service codes for maintenance and repair of dialysis vascular access (codes 36901-36908) after scheduled review of high-volume services. Since the implementation, these codes have made a significant impact on the industry in terms of reimbursement […]
