NEWS YOU CAN USE: New Year Brings New Codes and NCDs
• 2006 calls for remittance and reason code updates
Jan. 1, 2006, will bring a host of new and altered codes for remittance advice remarks and claim adjustment reasons, so make sure your facility has them on the books for claims you’ll submit next year.
There are nine entirely new codes for remittance advice remarks and a healthy handful of altered ones. Make sure you recognize the following new codes come Jan. 1:
• N348--You chose that this service/supply/drug would be rendered/supplied and billed by a different practitioner/supplier
• N349--The administration method and drug must be reported to adjudicate this service
• N350--Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or an unlisted procedure
• N351--Service date outside of the approved treatment plan service dates
• N352--There are no scheduled payments for this service. Submit a claim for each patient visit
• N353--Benefits have been estimated, when the actual services have been rendered, additional payment will be considered based on the submitted claim
• N354--Incomplete/invalid invoice
• N355--The law permits exceptions to the refund requirement in two cases…
• N356--This service is not covered when performed with, or subsequent to, a non-covered service.
The 24 new reason codes range from 167 to 189, and D21. You can read the full text of these changes at
www.cms.hhs.gov/Manuals/pm_trans/R743CP.pdf.
• Mark these lab changes for the new year
Time to update your laboratory National Coverage Determination (NCD) code lists to accommodate coverage changes that hit the books Jan. 1, 2006. Next year’s release of the edit module for clinical diagnostic lab services presents you with three main tasks:
1. Ax code V76.44 (Special screening for malignant neoplasms; other sites, prostate) from your list of ICD-9 codes not covered by Medicare.
2. Add the same code (V76.44) to the list of ICD-9 codes that don’t support medical necessity in the blood.
3. Add codes 158.8 (Malignant neoplasm of retroperitoneum and peritoneum; specified parts of peritoneum) and 158.9 (... peritoneum, unspecified) to the list of ICD-9 codes covered by Medicare in the tumor antigen by immunoassay CA 125 NCD.
• Lower limitations on your ESRD anemia management claims could pay off
Restrictive hematocrit/hemoglobin level limits for patients with end-stage renal disease (ESRD) will soon decrease on claims for anemia management drugs Epogen and Aranesp.
Old policy: The existing policy initiates monitoring actions at a hematocrit level of 37.5 percent (12.5 g/dL hemoglobin), but now this will change to 39 percent (hemoglobin 13.0 g/dL), according to a new policy CMS announced Nov. 9. Current industry guidelines require healthcare providers to maintain patients’ hematocrit levels within a 33 to 36 percent margin (10 to 12 g/dL hemoglobin), and Food and Drug Administration drug labeling recommends 25 percent Epogen and [...]
- Published on 2006-01-01
