Medicare Compliance & Reimbursement

Use C9723 when reporting blood perfusion imaging to Medicare.

Hospitals can anticipate payment for a wider variety of outpatient prospective payment system claims - and a lot of policy changes.

In an April Medlearn Matters article, the Centers for Medicare and Medicaid Services released a laundry list of payment changes for the OPPS April 2005 update. Now hospitals can get reimbursement under OPPS using these new codes:
   C9723 (Dynamic infrared blood perfusion imaging)  and C9724 (Endoscopic full-thickness plication in the gastric cardia using endoscopic plication system;includes endoscopy).
   Q4079 (Injection, Natalizumab, 1 mg) with status indicator "G", instead of  C9126.
   C9223 (Injection, adenosine for therapeutic or diag- nostic use, 6 mg, not to be used to report any adenosine phosphate compounds, instead use A9270) instead of J0150 and J0152.
   J9390 for generic (Vinorelbine tartrate, per 10 mg)  and C9440 for the brand name.
   C9127 (Injection, paclitaxel protein-bound particles, per 1 mg) and C9128 (Injection,pegaptamib sodium,per 0.3 mg). Don't Forget: CMS Deleted G0001 According to CMS, hospitals should also note these payment changes:    Look for status indicator "M" for services not billable to fiscal intermediaries or payable under the OPPS.
   Venipuncture code G0001 was deleted for services on or before Jan. 1. Use 36415 (Collection of venous blood by venipuncture) and 36416 (Collection of capillary blood specimen [e.g., finger, heel, ear stick]).
   OPPS reactivated modifier -27 (Multiple outpatient hospital E/M encounters on the same date), effective Jan. 1. For services provided between Jan. 1 and March 31, hospitals can submit an adjustment bill to receive payment for services related to modifier -27.

To read the entire Medlearn Matters article, go to www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3756.pdf.