Cardiology Coding Alert

Follow this checklist to get your claims accepted the first time.

Starting in July, you’ll need to be sure your transcatheter aortic valve replacement (TAVR) Medicare claims include a clinical trial number. Otherwise, you can expect to see those claims returned to you.

Check TAVR Claims for 3 Must-Haves

Here’s what Medicare wants to see on your professional claim for dates of service on or after July 1, 2013.

1. Include an 8-digit clinical trial (CT) registry number preceded by the letters CT “in Field 19 of paper Form CMS-1500 claims or entered similarly in the electronic 837P in Loop 2300 REF01 (REF01=P4),” states MLN Matters MM8255. CT numbers are maintained at www.cms.gov/Medicare/Coverage/Coverage-with-Evidence-Development/Transcatheter-Aortic-Valve-Replacement-TAVR-.html.

2. Append modifier Q0 (Investigational clinical service provided in a clinical research study that is in an approved clinical research study) on claim lines for TAVR codes 33361-33365 and 0318T (or 0256T-0259T for dates of service before Jan. 1, 2013). Recall that modifier 62 (Two surgeons) is also required on TAVR codes.

3. Add a secondary diagnosis of V70.7 (Examination of participant in clinical trial) on claim lines for those same TAVR codes. Under ICD-10, you’ll use Z00.6 (Encounter for examination for normal comparison and control in clinical research program).

Warning: If you leave out any of those elements, Medicare will return the claim as unprocessable.

Know the Where and When for Official Rules

Medicare released this new rule in Transmittal 2689, CR 8255, at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2689CP.pdf. The transmittal affects Medicare Claims Processing Manual, Chapter 32, Section 290.

You’ll find the associated MLN Matters MM8255 at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8255.pdf.

Dates: Note that although the effective date for the CT number rule is July 1, the implementation date is Oct. 7, 2013.

“The effective date identified in a change request (CR) is the date on which any new rules, laws, processes and/or policies become active,” states Medicare’s General Information, Eligibility, and Entitlement Manual, Chapter 7, Section 50.4. “The implementation date identified in a change request (CR) is the date by which Medicare fee-for-service contractors and shared system maintainers shall apply all changes detailed in the business requirements, unless otherwise specified.”

You can access Medicare’s online manuals from www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html.