Part B Insider (Multispecialty) Coding Alert

Published on Sat Nov 06, 2010 PDF

Plus: CMS debuts new specialty codes for sports medicine, cardiac EP specialists

Just last month, CMS announced its payment allowance for flu vaccine code 90658 -- and starting next month, you'll collect nothing for the code. That's the word from a new MLN Matters article, which CMS released among a torrent of other articles. Following is a breakdown of the highlights of CMS's latest releases.

Currently, you report 90658 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use) to signify that your physician administered a vaccine with preservatives to a patient over the age of three.

However, Medicare will no longer pay for claims with 90658 "effective for claims with dates of service on or after Jan. 1, 2011," CMS announced in MLN Matters article MM7234.

Instead, you'll have to bill based on the specific brand-name flu vaccine that the physician administers using the following new HCPCS codes that CMS has created:

• Q2035 -- Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use; Afluria
• Q2036 -- Flulaval
• Q2037 -- Fluvirin
• Q2038 -- Fluzone
• Q2039 -- Not otherwise specified

Important: Don't start submitting the new codes just yet. "CMS says in the announcement that the Q codes are in effect as of Oct. 1 and that you should use the new codes during the 2010-2011 flu season, but then later in the article it stresses that Medicare claims processing systems won't recognize the new codes yet," says coding consultant Jay Neal in Atlanta.

Here's what to do: If you vaccinate a Medicare patient between Oct. 1 and Dec. 31of this year, you can either bill immediately using 90658, or you can hold the claim and bill using the appropriate Q code after Feb. 7, 2011. Although CMS's original transmittal indicated that you could report the new Q codes as of Jan. 1, a subsequent directive that CMS issued on Nov. 30 said that claims processing systems may needuntil Feb. 7, 2011 to process the new codes.

Payment potential: Although CMS has not set payment limits for new codes Q2035 or Q2039, the payment allowances for the other new codes are as follows:

• Q2036 -- $7.439
• Q2037 -- $13.253
• Q2038 -- $12.593

Currently, the payment limit for 90658 is $11.368, so the new Q codes could represent a payment drop or boost, depending on which brand of vaccine you administer. To read the complete MLN Matters article, visit www.cms.gov/MLNMattersArticles/downloads/MM7234.pdf.

Check out Two New Specialty Codes In separate MLN Matters article number MM7209, CMS announced two new specialty codes effective April 1, 2011, as follows:

• Cardiac electrophysiology - Code 21
• Sports medicine -- Code 23

You can report your physician's services using one of these new specialty codes if the doctor self-designates his specialty as such during enrollment I Medicare or PECOS registration. If you are unsure of whether your physician has enrolled as a particular specialty, you can check your PECOS record using the Medicare online system at https://pecos.cms.hhs.gov.

To read the article on the new specialty codes, visit www.cms.gov/MLNMattersArticles/downloads/MM7209.pdf

CMS Introduces New Modifier

On Nov. 23, CMS also released article MM7087, which announced that for claims related to the 2010 oil spill in the Gulf of Mexico, you should append the following new modifier:

Modifier CS -- Item or service related, in whole or in part, to an illness, injury, or condition that was caused by or exacerbated by the effects, direct or indirect, of the 2010 oil spill in the Gulf of Mexico, including but not limited to subsequent clean-up activities

You can use this modifier for all Medicare claims related to the oil spill with dates of service on or after April 20, 2010. To read the accompanying MLN Matters article, visit www.cms.gov/MLNMattersArticles/downloads/MM7087.pdf.