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

Article for Determination of Cardiac Output by Inert Gas Rebreathing (0105T) – Related to LCDL25275 (A49865)This article will no longer be in effect for services performed after 12/31/2010.CPT code 0105T has been deleted effective 12/31/2010. Effective for dates of service on or after 01/01/2011,Category I CPT code 93799 should be used to report inert gas rebreathing for cardiac outputmeasurement during rest.Article for Colorectal Cancer Screening – Supplemental Instructions Article (A45928)The following article has been retired effective December 31, 2010. Details of the revisions are available inthe published documents and will also be included in the Updates notice published for February 1, 2011.Article for Transpupillary Thermotherapy (0016T) – Related to LCD L25275 (A49350)This article will no longer be in effect for services performed after 12/31/2010.CPT code 0016T has been deleted effective 12/31/2010. Effective for dates of service on or after 01/01/2011,Category I CPT code 67299 should be used to report destruction of localized lesion of choroid bytranspupillary thermotherapy.Article for Transurethral, radiofrequency micro-remodeling of the female bladder neck and proximalurethra for stress urinary incontinence (0193T) – Related to LCD L25275 (A49616)This article will no longer be in effect for services performed after 12/31/2010.CPT code 0193T has been deleted effective 12/31/2010. Effective for dates of service on or after 01/01/2011,Category I CPT code 53860 should be used to report transurethral radiofrequency micro-remodeling ofthe female bladder neck and proximal urethra for stress urinary incontinence.National Government Services Articles for Part A ProvidersTherapy Documentation Requirements for Part A Skilled NursingFacility ClaimsObjectiveThere are many elements involved in the review of a Part A skilled nursing facility (SNF) claim, but theprimary focus of this article is to address the therapy documentation requirements.Background• The Balanced Budget Act of 1997 changed the payment methodology for SNF to a prospectivepayment system (PPS). The eligibility and level of care requirements for SNF services as outlined in42 Code of Federal Regulations (CFR) 409.30 - 409.31, http://law.justia.com/us/cfr/title42/42-2.0.1.2.9.4.35.1.html did not change with the implementation of SNF PPS. The need for theserequirements to be met, in order for the beneficiary to qualify for a SNF admission, continued withSNF PPS. In addition, per 1862(a)(1)(A) of the Social Security Act,http://www.ssa.gov/OP_Home/ssact/title18/1833.htm, the services must be reasonable and necessaryfor the diagnosis or treatment of illness or injury or to improve the functioning of a malformed bodymember.Under SNF PPS, facilities receive per diem rates based on the beneficiary’s classification into a resourceutilization group (RUG). The minimum data set (MDS) is the clinical assessment tool utilized to classifybeneficiaries into each RUG group. Per CMS Internet-Only Manuals (IOMs), Publication 100-08, Chapter6, Section 6.1, http://www.cms.gov/manuals/downloads/pim83c06.pdf, “Medical review decisions areCPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 19 MMR 2011-01, January 2011