Look for New Codes, New Status Indicators in July ASC PS Update

The July update of the Ambulatory Surgical Center Payment System (ASC PS) implements several changes to Medicare billing instructions of which ASC coding and billing staff should be aware. The update includes new Category III codes, new instructions for device pass-through category C1840, and billing changes for medication. Billing staff, in particular, should take note of payment indicator changes for certain drug supply codes as claims adjustments may be necessary.

New Category III CPT® Codes

Ambulatory Surgical Center CASCC

For the July 2012 quarterly update of the ASC PS, the Centers for Medicare & Medicaid Services (CMS) is implementing seven Category III codes, effective July 1. The following five are separately payable under the ASC PS:

CPT® Long Descriptor ASC PI
0302T Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra-operative interrogation and programming when performed; complete system (includes device and electrode) J8
0303T Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra-operative interrogation and programming when performed; electrode only G2
0304T Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra-operative interrogation and programming when performed; device only J8
0307T Removal of intracardiac ischemia G2
0308T Insertion of ocular telescope prosthesis including removal of crystalline lens G2

Instructions for Device Pass-through Category C1840

Effective July 1, device pass-through category C1840 must be billed with CPT® code 0308T to receive payment. Category III code 0308T replaces HCPCS Level II code C9732 Insertion of ocular telescope prosthesis including removal of crystalline lens, which will be deleted June 30.

Billing for Drugs, Biologicals, and Radiopharmaceuticals

Two drugs and biologicals have been granted ASC payment status. These new codes are separately payable and are effective July 1:

HCPCS Long Descriptor PI
C9368 Grafix core, per square centimeter K2
C9369 Grafix prime, per square centimeter K2

An additional six new HCPCS Level II codes have been created for reporting certain drugs and biologicals effective July 1. The following five are separately payable under the ASC PS:

HCPCS Long Descriptor PI
Q2045 Injection, human fibrinogen concentrate, 1 mg K2
Q2046 Injection, aflibercept, 1 mg K2
Q2048 Injection, doxorubicin hydrochloride, liposomal, doxil, 10 mg K2
Q2049 Injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10 mg K2
Q2034 Influenza virus vaccine, split virus, for intramuscular use (Agriflu) L1

HCPCS Level II code Q2045 replaces J1680 Injection, human fibrinogen concentrate, 100 mg and Q2048 replaces J9001 Injection, doxorubicin hydrochloride, all lipid formulations, 10 mg. The payment indicators for both J1680 and J9001 will change to E5 Not payable by Medicare effective July 1.

HCPCS Level II code Q2046 replaces C9291 Injection, aflibercept, 2 mg vial, which will be deleted June 30.

Lastly, effective April 1, the payment indicators for the following codes have been changed from E5 (not payable by Medicare) to K2 Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on Outpatient Prospective Payment System.

Code Long Descriptor
90581 Anthrax vaccine, for subcutaneous or intramuscular use
J2265 Injection, minocycline hydrochloride, 1 mg
J8650 Nabilone, oral, 1 mg
Q0174 Thiethylperazine maleate, 10 mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q4123 Alloskin rt, per square centimeter
Q4125 Arthroflex, per square centimeter
Q4129 Unite biomatrix, per square centimeter

Payment rates for these codes are included in the revised April 2012 ASC drug file through implementation of the July 2012 ASC quarterly update. Suppliers who have received an incorrect payment for dates of service between April 1 and June 30 may request contractor adjustment.

These changes are being made to pub. 100-04 Medicare Claims Processing Manual, chapter 14, section 10 as per CMS transmittal 2479, change request (CR) 7854, issued May 25.

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One Response to “Look for New Codes, New Status Indicators in July ASC PS Update”

  1. Renee says:

    I am looking for information on Q4128 is it paid by medicare or considered experimental?

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