Part B Insider (Multispecialty) Coding Alert

Quarterly update announces additions, revisions, corrections

In a move sure to surprise some coders and exasperate others, CMS announced last week that it will reinstate four recently deleted HCPCS codes for Albuterol and Levalbuterol.

New codes: According to the latest HCPCS quarterly release, you-ll find 15 updates that take effect Apr. 1.

Five of these are additions to the HCPCS code set:

- K0672--Addition to lower extremity orthosis, removable soft interface, replacement only
- Q4096--Injection, Von Willebrand factor complex
- Q4097--Injection, immune globulin (Privigen), intravenous, non-lyophilized, 500 mg
- Q4098--Injection, iron dextran, 50 mg
- S3628--Placental alpha microglobulin-1 rapid immunoassay for detection of rupture of fetal membranes.

Coverage status: Of the five new codes above, CMS describes S3628 as -not payable by Medicare,- but the other four are payable based on -carrier judgment.-
-Although S3628 is not payable by Medicare, other insurers may pay it, which could pave the way for future Medicare coverage,- says Sarah King of Randall Ob-Gyn.

Codes reinstated: The new HCPCS code set reinstates Albuterol codes J7611 and J7613, as well as Levalbuterol codes J7612 and J7614. The coverage for these codes is noted as -special coverage instructions apply.-

Flashback: You may recall that last July, Medicare carriers began to deny payment for J7611-J7614, replacing them with Q4093-Q4094. 

-Both Q4093 and Q4094 were deleted effective Jan. 1, 2008,- says Jay Neal, a coding consultant in Atlanta. -HCPCS introduced new Albuterol-Levalbuterol combination codes J7602-J7603 to take the place of those deleted Q codes for 2008.-

In the new HCPCS revision effective April 1, CMS revises the status of Albuterol codes J7602-J7603 and iron dextran injection codes J1751-J1752 to -not payable by Medicare.-

-The most likely rationale for the flip-flop here is that Medicare decided it was a better idea to use the four codes that separated Albuterol from Levalbuterol, rather than the J7602-J7603 codes, which had combined them,- Neal says.

To review the HCPCS update, visit www.cms.hhs.gov/HCPCSReleaseCodeSets/02_HCPCS_Quarterly_Update.asp.