Oncology & Hematology Coding Alert

Question:  Can you clarify whether we'll need to use specialty code 95 for ADI?

Illinois Subscriber

Answer:  Specialty code 95 will not be available for use to indicate advanced diagnostic imaging (ADI) accreditation. ADI includes diagnostic MRI, CT, and nuclear medicine imaging such as PET, and excludes X-ray, ultrasound, and fluoroscopy.

History: In April 2011, CMS issued Transmittal 2192, indicating new specialty code 95 would apply to ADI accreditation.

But on June 24, CMS issued Transmittal 2248 (www.cms.gov/transmittals/downloads/R2248CP.pdf) eliminating the use of 95 for ADI. Instead, 95 will be defined as "open." As a result, the Provider Enrollment, Chain, and Ownership System (PECOS) will not recognize specialty code 95.

Caution: The specialty code rule may have changed, but one thing remains the same. To furnish the technical component of ADI services for Medicare beneficiaries, you must be accredited by Jan. 1, 2012. CMS will be able to verify that you're ADI-accredited via information sent by the three recognized accrediting organizations.