The Medicare Monthly Review, MMR-2011-01, January 2011 - CGS

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Article for Cardiovascular Nuclear Medicine - Supplemental Instructions Article (A46181)Article published January 2011: Annual LCD review per CMS Program Integrity Manual, Chapter 13,Section 13.4[C]. The coding requirements in the SIA were reviewed. Minor template changes were madeto reflect current template language.LCD for Category III CPT® Codes (L25275)R9 (effective 01/01/2011): based on the annual HCPCS update the following articles have been retired asthese Category III codes have been replaced with Category I codes:• A48043 - Anterior segment scanning computerized ophthalmic diagnostic imaging (0187T) –Related to LCD L25275• A49865 - Determination of Cardiac Output by Inert Gas Rebreathing (0105T) – Related to LCDL25275• A49350 - Transpupillary Thermotherapy (0016T) – Related to LCD L25275• A49616 - Transurethral, radiofrequency micro-remodeling of the female bladder neck andproximal urethra for stress urinary incontinence (0193T) – Related to LCD L25275No comment period required and none given.Article for Category III CPT® Code Coverage – Related to LCD L25275 (A46075)Article published January 2011: Based on the annual HCPCS update, CPT codes 0176T and 0177T havebeen deleted and replaced with Category I codes 66174 and 66175. The description for CPT code 0073Thas changed.Article for Collagenase clostridium histolyticum (e.g., Xiaflex ) – Related to LCD L25820 (A49949)Article published January 2011: Based on the annual HCPCS update for 2011, HCPCS code C9266 hasbeen deleted for dates of service after 12/31/2010 and HCPCS code J0775 has been added effective fordates of service on or after 01/01/2011 for services billed to the carriers or intermediaries or Part A or PartB MACs.LCD for Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy (L26404)R6 (effective 01/01/2011): The following limitation was removed:Marking of neoplasm for localization (tattooing) is covered, but is not separately payable.Minor template changes were made to reflect current template language. No comment and notice periodsrequired and none given.LCD for Computed Tomography (L28516)R9 (effective 01/01/2011): Due to the annual HCPCS update for 2011, CPT codes 74176, 74177 and 74178were added to the “CPT/HCPCS Codes” section. CPT codes 74176, 74177 and 74178 were also added tothe explanatory note in the “ICD-9-CM Codes that Support Medical Necessity” section for CT Abdomenand Pelvis.No comment and notice periods required and none given.Article for Computed Tomography – Supplemental Instructions Article (A48015)Article published January 2011: Due to the annual HCPCS update for 2011, the following codingguideline was revised:CPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 10 MMR 2011-01, January 2011
For dates of service prior to January 1, 2011, a CT scan of the abdomen and a CT scan of the pelvisperformed on the same day must be reported on the same claim.The following coding guideline was added:For dates of service on or after January 1, 2011, if a CT scan of the abdomen and pelvis are done on thesame day, the service should be billed with CPT code 74176, 74177 or 74178 as appropriate.CPT codes 74176, 74177 and 74178 were added to the “CPT/HCPCS Codes” section.Minor template changes were made to reflect current template language.LCD for Computerized Corneal Topography (L28201)R3 (effective 01/01/2011): Annual LCD review per CMS Program Integrity Manual, Chapter 13, Section13.4[C]. Content reviewed, and no changes required other than for minor formatting. No comment andnotice periods required and none given.Article for Computerized Corneal Topography – Supplemental Instructions Article (A48365)Article published January 2011: Annual review per CMS Program Integrity Manual, Chapter 13, Section13.4[C]. Content reviewed and no changes needed.LCD for Debridement Services (L27373)R8 (effective 01/01/2011): Due to the annual HCPCS update for 2011, the CPT code range of 11040 and11044 was revised to include 11045, 11046 and 11047 in the following paragraph in the “Indications”section:CPT codes 11042-11047 should be used for debridement of relatively localized areas depending upon theinvolvement of contiguous underlying structures. These codes are appropriate for treatment of skinulcers, circumscribed dermal infections, conditions affecting contiguous deeper structures, anddebridement of deep-seated debris from any number of injury types.CPT codes 11040 and 11041 were deleted 12/31/2010 and removed from the listing in the “CPT/HCPCSCodes” section of the LCD. An explanatory note regarding the code deletions was added to this section.CPT codes 11045, 11046 and 11047 were added. The terminology for CPT codes 11042, 11043 and 11044has been revised for dates of service on or after 01/01/2011.The following paragraph was removed from the “Utilization Guidelines” section:Debridement services of the feet is limited to two services per foot per clinical encounter, provided twodiscrete lesions are debrided to the level(s) coded. Services exceeding this parameter will be considerednot medically necessary.The following paragraph was added to the “Utilization Guidelines” section:Debridement services are now defined by body surface area of the debrided tissue and not by individualulcers or wounds. For example, debridement of two ulcers on the foot to the level of subcutaneous tissue,total area of 6 sq cm should be billed as CPT code 11042 with unit of service of “1”.The CPT codes 11046 and 11047 were added to the following paragraph was removed from the“Utilization Guidelines” section:CPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 11 MMR 2011-01, January 2011
Page 2 and 3: Centers for Medicare & Medicaid Ser
Page 4: National Government Services Articl
Page 7: R4 (effective 12/16/2010): Due to a
Page 13 and 14: For dates of service prior to 01/01
Page 15 and 16: Article for Magnetic Resonance Imag
Page 17 and 18: LCD for Scanning Computerized Ophth
Page 19 and 20: Article for Determination of Cardia
Page 21 and 22: • CMS Internet-Only Manual (IOM),
Page 23 and 24: to the third party but no notificat
Page 25 and 26: Provider Types AffectedThis article
Page 27 and 28: • HCPCS codes Q2026, Q2027, and G
Page 29 and 30: Calendar Year 2011 Annual Update fo
Page 31 and 32: Mapping Information• New code 829
Page 33 and 34: Waiver of Coinsurance and Deductibl
Page 35 and 36: Ambulance Inflation Factor for CY 2
Page 37 and 38: Key Points of CR 7049CMS is adding
Page 39 and 40: Medicare-covered preventive service
Page 41 and 42: staff, please visit http://www.cms.
Page 43 and 44: CMS has decided to follow the same
Page 45 and 46: 2011. This amendment’s expanded c
Page 47 and 48: • Rural Health Clinics (TOB 71X)
Page 49 and 50: Note: CMS requests provider, physic
Page 51 and 52: If you have any questions, please c
Page 53 and 54: Quarterly Update to Correct Coding
Page 55 and 56: • Peak oxygen consumption.Note: V
Page 57 and 58: more than 12 months after a person
Page 59 and 60: last year, increased by 1.1 percent
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CodePayment LimitQ4027 $17.23Q4028
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BillingIn general, it is inappropri
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Provider Action NeededImpact to You
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IntroductionAnnual outbreaks of sea
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• CMS Frequently Asked Questions
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Primary Care ServicesThe Affordable
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The Affordable Care Act authorizes
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Implementation of Changes in End-St
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Home Health Face-to-Face Encounter
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collaborate with and inform the com
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News Flash - A revised Medicare Lea
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DisclaimerThis article was prepared
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Provider Types AffectedThis program
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News Flash - Each Office Visit is a
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Provider Types AffectedPhysicians,
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On January 28, 2010, CMS made avail
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spelling the Ordering/Referring Pro
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• Doctor of podiatric medicine;
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ased on the CPT code descriptor, re
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The Medicare Monthly Review, MMR-2011-01, January 2011 - CGS

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