CMS Releases 2016 HCPCS Corrections

CMS Releases 2016 HCPCS Corrections

By Brad Ericson, MPC, CPC, COSC

The Centers for Medicare and Medicaid Services released 49 corrections to the 2016 HCPCS Level II code set December 2, too late to be included in any 2016 HCPCS Level II codebook because publishers had already sent their books to print. But don’t fail to update as there are around 350 new edits in the 2016 HCPCS books already.

Some changes, such as G0477-G0483, were foreshadowed in the final CLIA guidelines for 2016, but most are changes to descriptions and deletions since the release of the data a month prior. All go into effect January 1, 2016. Here are the changes:

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CODE ACTION EFF DATE SHORT DESC LONG DESC
G0298 Remove code – not valid (was replaced with G0475)
G0472 Add pricing indicator 21 1/1/2016
G0477 Add new code 1/1/2016 Drug test presump optical Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service
G0478 Add new code 1/1/2016 Drug test presump opt inst Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) read by instrument-assisted direct optical observation (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service
G0479 Add new code 1/1/2016 Drug test presump not opt Drug test(s), presumptive, any number of drug classes; any number of devices or procedures by instrumented chemistry analyzers utilizing immunoassay, enzyme assay, TOF, MALDI, LDTD, DESI, DART, GHPC, GC mass spectrometry), includes sample validation when performed, per date of service
G0480 Add new code 1/1/2016 Drug test def 1-7 classes Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 1-7 drug class(es), including metabolite(s) if performed
G0481 Add new code 1/1/2016 Drug test def 8-14 classes Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 8-14 drug class(es), including metabolite(s) if performed
G0482 Add new code 1/1/2016 Drug test def 15-21 classes Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 15-21 drug class(es), including metabolite(s) if performed
G0483 Add new code 1/1/2016 Drug test def 22+ classes Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 22 or more drug class(es), including metabolite(s) if performed
G6030 Delete code 1/1/2016
G6031 Delete code 1/1/2016
G6032 Delete code 1/1/2016
G6034 Delete code 1/1/2016
G6035 Delete code 1/1/2016
G6036 Delete code 1/1/2016
G6037 Delete code 1/1/2016
G6038 Delete code 1/1/2016
G6039 Delete code 1/1/2016
G6040 Delete code 1/1/2016
G6041 Delete code 1/1/2016
G6042 Delete code 1/1/2016
G6043 Delete code 1/1/2016
G6044 Delete code 1/1/2016
G6045 Delete code 1/1/2016
G6046 Delete code 1/1/2016
G6047 Delete code 1/1/2016
G6048 Delete code 1/1/2016
G6049 Delete code 1/1/2016
G6050 Delete code 1/1/2016
G6051 Delete code 1/1/2016
G6052 Delete code 1/1/2016
G6053 Delete code 1/1/2016
G6054 Delete code 1/1/2016
G6055 Delete code 1/1/2016
G6056 Delete code 1/1/2016
G6057 Delete code 1/1/2016
G6058 Delete code 1/1/2016
G8925 Change Short and Long Desc 1/1/2016 FEV>=60% & no COPD sym Spirometry test results demonstrate FEV1 >= 60% predicted or patient does not have COPD symptoms
G9226 Remove ? in Long Desc 1/1/2016 Foot examination performed (includes examination through visual inspection, sensory exam with 10-g monofilament plus testing any one of the following: vibration using 128-Hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold, and pulse exam; report when all of the 3 components are completed)
G9448 Remove ? in Long Desc 1/1/2016 Patients who were born in the years 1945-1965
G9574 Remove the period in Long Desc 1/1/2016 Remission at six months not demonstrated by a six month (+/-30 days) phq-9 score of less than five; either phq-9 score was not assessed or is greater than or equal to five
G9666 Remove ? in Long Desc 1/1/2016 The highest fasting or direct ldl-c laboratory test result of 70-189 mg/dl in the measurement period or two years prior to the beginning of the measurement period
G9668 Remove code – not valid
G9676 Remove ? In Long Desc 1/1/2016 Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes and with an LDL-C result of 70-189 mg/dL recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period
J0571 Change Long Desc Buprenorphine, oral, 1 mg
J7205 Change Long Desc 1/1/2016 Injection, factor viii fc fusion protein (recombinant), per iu
L1902 Long desc – “similiar” should be “similar” Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf
L1904 Long desc – “similiar” should be “similar” Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated
Q9975 Change Long Desc 4/1/2015 Injection, factor viii fc fusion protein (recombinant), per iu

 

Brad Ericson

Brad Ericson

Publisher at AAPC
Brad Ericson, MPC, CPC, COSC, has been publisher for more than nine years. Before AAPC he was at Optum for 13 years and at Aetna Health Plans before that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.
Brad Ericson

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About Has 193 Posts

Brad Ericson, MPC, CPC, COSC, has been publisher for more than nine years. Before AAPC he was at Optum for 13 years and at Aetna Health Plans before that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.

4 Responses to “CMS Releases 2016 HCPCS Corrections”

  1. Anu Sriram says:

    2016 New drug testing G-codes G0477 – G0483 are not being accepted by Medicare until April 2016 (claims being denied) since addendum B is yet to be updated due to the delayed release. Do you have any updates on this?

  2. Jan Kehlenbeck says:

    J7205 cpt code’s are begin denied from medicare for units- But we have it as 1 units and they are stating that box 19 needs the frequency?? We are stomped and don’t know what the correct answer is

  3. Bev Prudhomme says:

    Our latest quarterly HCPCS shows that CMS is re-activating G0298 – does anyone know what it going on with this change? Thanks

  4. Imran says:

    Can anyone tell me the replacement code of G9584 as it is being denied by MCR and MCD continuously. Your response will be highly appreciated.

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