Wiki CPT 64595 edit for device code

abb

New
Messages
7
Best answers
0
Hi,

MCR is denying CPT 64595 for device-dependent procedure reported without device code. 64595 is Revision/removal of peripheral or gastric neurostimulator pulse generator or receiver. In this case, it was removed, no device was placed. I've been told by billing the device code can't be added with a $0 charge, so I am unsure what to do here. Anyone else run into this issue?

Thanks!
 
Hey Thomas,

Do you have a link to the source for this? I have been dealing with this problem for months and this would help tremendously, thank you!

I learned of this from an article in the October 2019 issue of Briefings on APCs which is a publication that my employer subscribes to. As their source, they reference the OCE Quarterly Release Filed from October 2019 - I've attached a link below to the CMS publication showing the change. The article does note that at the time of the publication of this change, it had not been addressed in the policy manuals, and I'm not sure if any other official guidance has come out from CMS since then, but this is clearly the intent of the update to the claim editor.

 
I have come across this also and I believe it must be an error in the way the OPPS was set up for this code. Unfortunately I have not seen any official guidance on how this should be resolved and have not had any communications with billing departments as to how they were able to deal with it. I'm not sure why your billing department is saying you can't add the $0 charge though - you can bypass the edit with an unlisted device code, e.g. L8699. You may need to contact your Medicare contractor and escalate the issue. If you find out something more definitive though, I'd be interested in knowing what the resolution is.
 
Hi,

MCR is denying CPT 64595 for device-dependent procedure reported without device code. 64595 is Revision/removal of peripheral or gastric neurostimulator pulse generator or receiver. In this case, it was removed, no device was placed. I've been told by billing the device code can't be added with a $0 charge, so I am unsure what to do here. Anyone else run into this issue?

Thanks!

I've just come across some new guidance that went into effect at the beginning of this year, but retroactive to the beginning of 2019, that for outpatient hospital claims Medicare has instructed to append modifier CG to device-dependent CPT codes in cases when no device was used. This should allow you to bypass the edit now. (Apparently, for ASCs, there is also the option of billing HCPCS code C1890 to indicate no device used, however, this code is not recognized for hospitals.)

I have not had the opportunity to test this out on a live claim, but thought I'd put the information out there in case anyone comes across the situation again.
 
I've just come across some new guidance that went into effect at the beginning of this year, but retroactive to the beginning of 2019, that for outpatient hospital claims Medicare has instructed to append modifier CG to device-dependent CPT codes in cases when no device was used. This should allow you to bypass the edit now. (Apparently, for ASCs, there is also the option of billing HCPCS code C1890 to indicate no device used, however, this code is not recognized for hospitals.)

I have not had the opportunity to test this out on a live claim, but thought I'd put the information out there in case anyone comes across the situation again.
Hey Thomas,

Do you have a link to the source for this? I have been dealing with this problem for months and this would help tremendously, thank you!
 
Hi all. I was trying to get a facility claim billed with the CG modifier, but our MAC is returning the claim for a device-dependent procedure without a device despite the modifier. I know we can add a penny charge for a miscellaneous device, but truthfully that is what the CG should be preventing. There are several procedures where we are having this issue, but one is CPT 26530, Arthroplasty, metacarpophalangeal joint; each joint. The physician used low cost sutures to stabilize the tendon/joint and no other implants, and our Sr. Analyst doesn't feel we should report standard sutures as the implant just to bypass the edit. Have you had any issues with the CG modifier not clearing the edit for these device-dependent procedures? Does CMS have any information on which procedures are allowed with a CG vs. those that are not?
 
Hey all, for anyone still wondering about the CG modifier being utilized to account for Device-Dependent procedures that are actually just revisions/adjustments of an already-implanted device, there is a list on the CMS site called the Edit 92 bypass List;

You can filter and crosswalk this spreadsheet to find which CPT's that are applicable for the CG modifier. The link to the IOCE quarterly release files is attached below, simply download the quarter you need to reference, open it (under the Report Tables tab > Data_HCPCS.xlsx) and filter your spreadsheet to the column for "device_procedure" (this column is BS on the Jan 2022 version of the document) and "1" for yes to show DDP's eligible for this CG mod:

Link: https://www.cms.gov/Medicare/Coding/OutpatientCodeEdit/OCEQtrReleaseSpecs
 
Top