The Edge Blast E-Newsletter
Issue #95
posted 02/20/2008
Electronic news for February 2008

Read the EdgeBlast and Earn CEUs Toward Your Annual Renewal
Earn continuing education units (CEUs) by reading the EdgeBlast. Simply answer the five questions found in the EdgeBlast Test Yourself at the end and submit your answers at the time of your renewal, using the same process you follow monthly for the Test Yourself in the AAPC Cutting Edge. Each EdgeBlast (there are two issued each month) will feature five questions that are worth 0.5 CEUs, for a total of 12 CEUs annually.


Get CMS QPU While It's Hot!

The January 2008, Centers For Medicare and Medicaid Services (CMS) Quarterly Provider Update (QPU) was updated between the dates Feb. 1, 2008 and Feb. 6, 2008. The updates include recently released instructions and published regulations.

To view QPU documents, go to the What's New page at:
http://www.cms.hhs.gov/quarterlyproviderupdates/downloads/January08whatsnew.pdf

To see released instructions and regulations, visit the QPU home page at:
http://www.cms.hhs.gov/QuarterlyProviderUpdates
You can be notified periodically by email of CMS regulations and program instructions added to the QPU, by signing up for The CMS-QPU Listserv at:

https://list.nih.gov/cgi-bin/wa?SUBED1=cms-qpu&A=1



Some Heart Disease Screening Covered

Valentine's Day may be over but heart awareness continues throughout the month of February. Since 1999, February has been American Heart Month and we've seen a decline of death rates from coronary heart disease and stroke in Americans. To help spread the word about cardiovascular disease prevention, CMS reminds health care professionals that Medicare beneficiaries are covered for certain cardiovascular screening blood tests. The screening will help beneficiaries learn if they have an increased risk of heart disease and stroke.

Medicare covers the following cardiovascular screening blood tests to detect cardiovascular disease or abnormalities associated with heart disease and stroke:

  • Total cholesterol test
  • Cholesterol test for high-density lipoproteins
  • Triglycerides test

Coverage of cardiovascular screening blood tests is provided as a Medicare Part B benefit. The beneficiary will pay nothing for the blood tests. (There is no coinsurance or copayment and no deductible for this benefit.)
For more information about cardiovascular screening benefits, go to the CMS website at: http://www.cms.hhs.gov/CardiovasDiseaseScreening/

To learn more about American Heart Month, check out the links:



GAO: More Work Needed on HIT Strategy

There is still a large amount of work to be done to develop a national strategy for Health Information Technology (HIT), the U.S. Government Accountability Office (GAO) reported this month in testimony before the budget's Senate Committee.

Since it was established in 2004, the Office of National Coordinator for Health Information Technology has received $200 million in funding to encourage and support efforts of technology adoption nationwide. It received $61 million for 2008, and has requested $66 million for 2009. In addition to the budgeted expenses for 2009, the office has requested $3.8 million to fund a second year of a CMS project to provide financial incentives to physician practices adopting Electronic Medical Records (EMRs). Despite the advances in the Office of National Coordinator for HIT, U.S. Department of Health & Human Services (HHS) has not yet defined detailed plans and milestones for integrating or tracking HIT initiatives, the GAO report said.

The President has set a national goal for widespread adoption of interoperable electronic health records by 2014.



BMM Billing Requirement Changes

On Jan. 18, CMS released transmittal 1416 to clarify Bone Mass Measurement (BMM) billing requirements, which will be implemented on Feb. 20, 2008. The summary of changes is for the claims processing instructions contained in CR 5521.

Some of the changes as described in chapter 15, section 80.5.5 of the Medicare Benefit Policy Manual are:

  • Certain BMM tests are covered when used to screen patients for osteoporosis according to the frequency standards. Contractors will pay claims for screening tests when the CPT® procedure code 77078, 77079, 77080, 77081, 77083, 76977 or G0130, is reported and contains a valid ICD-9-CM diagnosis code including the reason for testing indicating postmenopausal female, vertebral fracture, hyperparathyroidism, or steroid therapy. Without a proper diagnosis the claim will be denied.
  • Dual-energy x-ray absorptiometry (axial) tests that are covered when used to monitor FDA-approved osteoporosis drug therapy according to the two-year frequency standards. Contractors will pay claims for monitoring tests when coding CPT® procedure code 77080, with an ICD-9-CM diagnosis code of 733.00, 733.01, 733.02, 733.03, 733.09, 733.90, or 255.0. A denial of claims will occur for monitoring tests when coding CPT® procedure code 77078, 77079, 77081, 77083, 76977 or G0130, with 733.00, 733.01, 733.02, 733.03, 733.09, 733.90, or 255.0 but does not include the reason for testing indicating postmenopausal female, vertebral fracture, hyperparathyroidism, or steroid therapy.

Single photon absorptiometry tests aren't covered and contractors will deny CPT® procedure code 78350.

For the complete transmittal that summarizes the specifics of the change, go to the CMS website at: http://www.cms.hhs.gov/transmittals/downloads/R1416CP.pdf


New Medicare Rules for Panel Codes

Changes to the Pathology/Laboratory section of CPT® weren't as extensive as in previous years. However, according to CMS, the new code 80047 Basic metabolic panel (Calcium, ionized) requires a new approach which has added 82330 Calcium; ionized to the automated multi-channel chemistry code (AMCC) Panel Payment Algorithm.

The new code 80047 is comprised of eight component test codes. The Medicare agency cautions new code 80047 is not a replacement for code 80048 Basic metabolic panel. Both codes 80048 and 80047 are included in the 2008 clinical laboratory fee schedule.

Existing CPT® code 82330 is paid as in individual test and was not included in the AMCC Panel Payment Algorithm. CMS decided that, effective July 1, 2008, CPT® 82330 shall be paid as an automated test and that the ATP payment methodology is appropriate for this service.

CPT® code 80047 comprises the following:

82330   Calcium; ionized

82374   Carbon dioxide (bicarbonate)

82435   Chloride; blood

82565   Creatinine; blood

82947   Glucose; quantitative, blood (except reagent strip)

84132   Potassium; serum

84295   Sodium; serum

84520   Urea Nitrogen; quantitative

For more information, check out http://www.cms.hhs.gov/transmittals/downloads/R83BP.pdf.

EdgeBlast Test Yourself

By answering the following questions, you can earn 0.5 continuing education units to apply toward your annual AAPC CEU renewal every two years. Simply answer the questions and send in a copy of your work when submitting your CEU package. Do put the number of each EdgeBlast included in your submission. The number is available at the top of the page.

Answers to the questions are not always found directly (word for word) in the EdgeBlast in which they appear. While often related to the EdgeBlast content, they require additional resources, such as your ICD-9-CM, CPT® and HCPCS manuals.

Index # EB02022008A

1. You can be notified periodically by email of CMS regulations and program instructions added to the QPU by signing up for what?

Answer:

2. Coverage of cardiovascular screening blood tests is provided as a benefit under whom?

Answer:

 

3. Medicare contractors will pay claims for dual-energy x-ray absorptiometry (axial) tests when using what CPT® procedure code with an ICD-9-CM diagnosis code of 733.00, 733.01, 733.02, 733.03, 733.09, 733.90, or 255.0?

Answer:

 

4. "Single photon absorptiometry tests" is paraphrased to describe code 78350. What is the official CPT® descriptor for code 78350?

Answer:

 

5. Medicare covers what three cardiovascular screening blood tests to detect cardiovascular disease or abnormalities associated with heart disease and stroke?

Answer:

 

CPT® codes Copyright 2007 American Medical Association. All Rights Reserved.
CPT® is a trademark of the AMA.
CPC™ is trademark of AAPC
No fee schedules, basic units, relative values or related listings are included in CPT®.
The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.