News You Can Use: Medicare to Reimburse 2 More PET Scans

  Open those wallets, hospitals: Starting Oct. 1, youll get paid for more positron emission tomography (PET) scans. For services rendered on or after that date, Medicare covers scans for fluoro-D-glucose PET for thyroid cancer and perfusion of the heart using ammonia N-13. As always, though, youve got conditions to meet, and this time theyre very specific:
 
Thyroid cancer: Physicians can use the test only for restaging. As for the nature of the cancer, you wont earn reimbursement unless its:

  recurrent or residual
  of follicular cell origin
  previously treated by thyroidectomy and radioiodine ablation.
 
Youll also need to check the patients serum thyroglobulin, which must be more than 10 ng/ml. Report this scan using new code G0296 (PET imaging, full and partial ring PET scanner only, for restaging of previously treated thyroid cancer of follicular cell origin following negative I-131 whole body scan).
 
Perfusion of the heart using ammonia N-13: You must perform the test in lieu of a single photon emission computed tomography (SPECT), unless the patient has already undergone an inconclusive SPECT that was necessary to decide on treatment. Use the code series G0030-G0047 to report this test, and bill the ammonia N-13 tracer with new code Q0478 (Supply of radiopharmaceutical diagnostic imaging agent, ammonia N-13, per dose). Codes Q3000 ( rubidium Rb-82, per dose) and Q0478 are the only tracers Medicare covers.

  Medicare reimbursement will soon come your way for the previously noncovered codes L8110 (Gradient compression stocking, below knee, 30-40 mmhg, each) and L8120 ( 40-50 mmhg, each). After Oct. 1, you can bill for these devices when the patient suffers from an open venous stasis ulcer that a medical professional who performed medically necessary debridement has already treated. Report them using modifier  -AW (Item furnished in conjunction with a surgical dressing).
 
 Effective Oct. 16, Medicare retires these five remittance advice remark codes, and replaces them with older, similar codes:
 
M72 Did not enter full 8-digit date (MM/DD/CCYY). MA52 (Missing/incomplete/ invalid date) will appear instead.
 
MA05 Incorrect admission date, patient status, or type of bill entry on claim. Youll see one of the following codes in its place: MA52 (Missing/ incomplete/Invalid type of bill), MA40 (Missing/incomplete/invalid admission date) or MA43 (Missing/ incomplete/invalid patient status).
 
MA98 Claim rejected. Does not contain the correct Medicare Managed Care Demonstration contract number for this beneficiary. Report MA97 (Missing/incomplete/ invalid Medicare Managed Care Demonstration contract number) in lieu of MA98.
 
N41 Authorization request denied. Instead, youll see Claim Adjustment Reason Code 39 (Services denied at the time authorization/pre-certification was requested).
 
N44 Payers share of regulatory surcharges, assessments, allowances, or health-care related taxes paid directly to the regulatory authority. Look for Claim Adjustment Reason Code 137 (Payment/reduction for regulatory surcharges, assessments, allowances, or health-related taxes) where N44 would have been.

- Published on 2003-07-01