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Eli's Rehab Report

A4644-A4646 Got You Doing a Double Take?

Published on Wed Jan 12, 2005

Medicare creates A9525 instead, then cancels it

If you're confused about which low osmolar contrast material (LOCM) codes to use, you're not the only one. But your 2005 HCPCS book brings relief. As of Jan. 1, most carriers should be recognizing A4644-A4646.

Important: "You should use any new code available as of Jan. 1, because Medicare is not offering the usual 'phase-in' period for new codes," says Roseanne Wholey, president of Roseanne R. Wholey and Associates, a medical reimbursement consulting firm in Oakmont, Pa.

3 Codes Are Better Than 1

When you prepare to code for LOCM in 2005, you'll have three codes to choose from:
 

  • A4644 - Supply of LOCM of 100-199 mgs of iodine
     
  • A4645 - Supply of LOCM of 200-299 mgs of iodine
     
  • A4646 - Supply of LOCM of 300-399 mgs of iodine.

    "In this instance, three codes are better than A9525 (Low or iso-osmolar contrast material, 10 mg of iodine) because each of these codes represent a specific dosage," says Sandra Soerries, CPC, CPC-H, a healthcare reimbursement consultant at BKD, LLP in Kansas City, Mo. "You need to pay particular attention to the description of the dosage of LOCM being administered for selecting the correct code."

    The reason behind retaining these codes may be that  CMS feared one catchall code would lead to incorrect coding of LOCM charges, says BCBS of Kansas' April 1, 2004, "Latest News."

    You can expect the reimbursement for A4644-A4646 to be 108 percent of the average sales price (ASP), according to the CMS 2005 Federal Register.

    Note: This information is in detail on page 582 and summarized on page 777 at     www.cms.hhs.gov/regulations/pfs/2005/1429fc/master_background_1429-fc.pdf.

    Cardiac Patients Tolerate LOCM Better

    Physicians use LOCM for patients needing a procedure (such as, MRI or CT) that uses a contrast material to enhance images. LOCM is a water-soluble contrast medium with low osmolality.

    Think of it this way: Ordinary iodinated contrast media have a higher osmolality than the low osmolar or iso-osmolar contrast media, Wholey says. The organic bound iodinated contrast media comes back opaque in the x-ray and consequently provides the image.

    Patients with renal insufficiency or congestive failure tolerate the non-ionic, low molecular weight osmolar (the osmolality of blood) or iso-osmolar contrast media better than the ionic contrast media, Wholey says.

    Learn the History Behind LOCM Codes

    After a confusing round of deleting LOCM codes A4644-A4646 and replacing them with the catchall A9525, then canceling A9525 and reinstating A4644-A4646 a mere three months later, many carriers have been slow to update their files - which means you've been left wondering who accepts what.
     
    To provide some perspective, here's the history behind these codes:
     

  • On Jan. 1, 2004, Medicare deleted A4644-A4646 and added A9525 as a catchall. You should have stopped using A4644-A4646 and reported only A9525 for LOCM.

     

  • On April 1, 2004, Medicare canceled A9525 and reinstated A4644-A4646. Some carriers don't update their files quarterly, so you may have continued to code A9525. Other carriers, like Medicare, immediately asked that you return to using A4644-A4646.

     

  • On Jan. 1, 2005, HCPCS officially contained A4644-A4646. Contrary to expectations, HCPCS doesn't delete A9525 entirely but lists it as a code noncovered by Medicare. Most carriers should be recognizing A4644-A4646 for LOCM. If you report A9525 for Medicare, you'll receive a denial.

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