Cardiology Coding Alert

See whether tobacco-related illnesses are still a 99406 must.

Coverage changes are in the works at Medicare. Here's what's coming down the pike for MRA and tobacco cessation services. Mix and Match MRI and MRA Coverage Sometimes one coverage change leads to another.

When CMS decided to remove the phrase "blood flow measurement" from MRI's Nationally Noncovered Indications at 220.2(C)(2) of the National Coverage Determinations (NCD) Manual, the agency announced a decision to review evidence on non-covered indications for magnetic resonance angiography (MRA), too.

Result: CMS recently announced that local Medicare contractors will be the ones to decide whether to cover MRA services not specifically designated as nationally covered or non-covered.

In short, the decision states that CMS will merge the NCDs for MRI and MRA. And as part of the merging, CMS will maintain existing national coverage but will eliminate non-coverage language for MRA.

For practices that perform imaging, "the change in the national MRA policy is huge," says Anne C. Karl, RHIA, CCS-P, CPC, CCC, coding and compliance specialist with St. Paul Heart Clinic in Minnesota.

For example: "Previously MRA of the chest [71555, Magnetic resonance angiography, chest [excluding myocardium], with or without contrast material[s]) was limited to pulmonary emboli and thoracic aneurysm, and now the local carriers will have jurisdiction," Karl says.

Resource: You can download the transmittal announcing the change at www.cms.gov/transmittals/downloads/R123NCD.pdf. Watch for Additional 99406-99407 Opportunities If you've been writing off tobacco cessation counseling as nonpayable, it's time to change your tune.

In the past, you could collect for codes 99406-99407 (Smoking and tobacco use cessation counseling visit ...) if you performed tobacco cessation counseling for a patient with a tobaccorelated disease or with signs or symptoms of one. But on Aug. 25, CMS announced that "under new coverage, any smoker covered by Medicare will be able to receive tobacco cessation counseling from a qualified physician or other Medicarerecognized practitioner who can work with them to help them stop using tobacco."

"For too long, many tobacco users with Medicare coverage were denied access to evidence-based tobacco cessation counseling," said Kathleen Sebelius, HHS secretary, in an Aug. 25 statement. "Now, older adults and other Medicare beneficiaries can get the help they need to successfully overcome tobacco dependence."

The expanded coverage announcement is part of a focus in the Affordable Care Act, effective Jan. 1, 2011, that expands preventive care service coverage. The new tobacco cessation counseling coverage expansion will apply to services under Medicare Part B and Part A.

"The new benefit will cover two individual tobacco cessation counseling attempts per year," CMS indicated in an Aug. 25 news release. "Each attempt may include up to four sessions, with a total annual benefit thus covering up to eight sessions per Medicare patient who uses tobacco."

"We know that older adults and other Medicare beneficiaries can be successful in their struggles to stop using tobacco, as long as they have the right resources available to them," said HHS's Howard Koh, MD, MPH, in an Aug. 25 statement. "Today's decision will assure that beneficiaries can access that help from qualified physicians and other Medicare-recognized practitioners."

To read the complete coverage decision, visit www.cms.gov/center/coverage.asp. Click on "NCAs," then scroll down to "Smoking & Tobacco Use Cessation Counseling." Or go straight to the decision memo at www.cms.gov/mcd/viewdecisionmemo.asp?id=242.

Bonus tip: Check your payers for documentation requirements. For example, during the initial visit of each attempt (Medicare covers two individual attempts per year) some experts suggest documenting a complete history and physical explaining in detail the subjective (such as information from the patient on tobacco use and health issues), objective (such as height and weight), and plan (such as behavioral and medication options) so you support medical necessity for smoking and tobacco cessation counseling.