Radiology Coding Alert

CMS Update:

News Flash--You Must Now Look for Category III CTA Professional and Technical Components

Published on Tue May 23, 2006

Use this chart to get a quick rundown of important changes you need to know

CMS has been busy churning out new rules and guidance. Here's a breakdown of the changes that affect you most.

Subject: 2006 Medicare Physician Fee Schedule April Update
MLN: http://www.cms.hhs.gov/Transmittals/downloads/R897CP.pdf
Implementation Date: April 3, 2006
What you need to know: Heart CT and CTA codes 0144T-0151T now have professional (modifier 26) and technical (modifier TC) components, so you need to append these modifiers when appropriate. Example: Append 26 to the code when the radiologist performs the test at a hospital.

Subject: Expanded PTA Coverage
MLN: www.cms.hhs.gov/MLNMattersArticles/downloads/MM3811.pdf
Implementation Date: July 5, 2005; Revised: April 3, 2006
What you need to know: The coverage revision clarifies that hospitals may report both ICD-9 433.30 (Occlusion and stenosis of precerebral arteries, multiple and bilateral, without mention of cerebral infarction) and 433.10 (Occlusion and stenosis of precerebral arteries, carotid artery, without mention of cerebral infarction) in any diagnosis positions on the same claim for carotid artery PTA with placement of an FDA-approved carotid stent with embolic protection. Identify the bilateral condition with 433.30 and the carotid vessel with 433.10.

CMS made the revision to reduce confusion caused by a 2002 Coding Clinic Q&A instructing coders to report 433.10 as the principal diagnosis for bilateral carotid artery stenosis and a subsequent correction saying to use 433.30 instead.

Subject: Surrogate UPIN Still OK--for Some
MLN: www.cms.hhs.gov/MLNMattersArticles/downloads/MM5019.pdf
Implementation Date: April 3, 2006
What you need to know: With CR5019, CMS rescinds CR4177, which instructed you to stop using surrogate UPIN OTH000 (see the March issue of Radiology Coding Alert). CR5019 states that Medicare contractors should continue to use the surrogate UPIN for claims and internal purposes for diagnostic, radiology, and consultation services, as well as durable medical equipment, during an interim period when you've requested but have yet to receive a UPIN.

CMS rescinded CR4177 to help providers continue to submit claims.

Important: IDTFs aren't as lucky. CMS did NOT rescind the transmittal eliminating UPINs for IDTFs (CR4096, www.cms.hhs.gov/transmittals/downloads/R769CP.pdf). CMS reissued that transmittal with a new effective date of Jan. 3, 2006.

Subject: New CMS-1500 on the Way
MLN: www.cms.hhs.gov/MLNMattersArticles/downloads/MM4293.pdf
Implementation Date: Oct. 2, 2006
What you need to know: If you still submit Medicare claims on paper, start using up that stack of forms. To accommodate the switch to the National Provider Identifier (NPI), Medicare is replacing CMS-1500 (12/90) with CMS-1500 (08/05). You can start using the new form as early as Oct. 1, 2006, but you won't be required to use it until Feb. 1, 2007.