Oncology & Hematology Coding Alert

CMS encourages local payers to create their own lists for Types II and III.

In an effort to connect add-on codes with appropriate primary codes, CMS Transmittal 2636, CR 7501, provides three tables classifying three types of add-on codes.

Type I: The Type I add-on codes in the Transmittal’s first table are paired only with primary codes specified by the CPT^® manual. Medicare will not pay a Type I add-on code unless one of the specified primary codes is also reported.

The exception is +99292 (Critical care … each additional 30 minutes …). A second physician may report +99292 without 99291 (Critical care … first 30-74 minutes) “if another physician of the same specialty in his group practice is paid for CPT^® code 99291 on the same date of service,” the Transmittal states. (For more on critical care, see Medicare Claims Processing Manual, Chapter 12, Section 30.6.12, www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html).

Type II: Type II add-on codes are those that have no primary codes listed by CPT^®. “Claims processing contractors are encouraged to develop their own lists of primary procedure codes for this type,” the Transmittal states. CMS posts non-exhaustive lists of possible primary codes for some, but not all, of the Type II codes.

Type III: For the add-on codes labeled as Type III codes, CPT^® lists some but not all primary code possibilities. In addition to the CPT^®-designated possible codes, CMS encourages contractors to create their own lists of appropriate primary codes.

Resources: You can review the Transmittal at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2636CP.pdf. The effective date is April 1, 2013.

Note that the Correct Coding Initiative manual also includes a section about the tables. The language is similar to the Transmittal regarding the required use of proper primary codes for payment and contractors creating lists of appropriate primary codes for Type II and Type III codes. You can get the manual from the Downloads section of www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/.