Issue #99 - April 16, 2008  
AAPC

Most ICD-9 Changes in Decade Proposed
The Centers for Medicare and Medicaid Services (CMS) announced April 15 its proposed changes to ICD-9-CM for 2009, and the number of new codes this year is the most in more than a decade. More than 330 new diagnosis codes are proposed and will be posted in an upcoming Federal Register.

Included are codes classifying carcinoid tumors by site; secondary diabetes mellitus in its own category 249; more than two dozen new headache codes; retinopathy of prematurity codes by stage; pressure ulcers by stage; and newborn necrotizing enterocolitis by stage. More than a dozen codes associated with Pap smears and HPV and 25 obstetrics and gynecology codes were also added.

In addition to the 330 proposed diagnosis codes, another set of more than 120 diagnosis codes was presented in April to CMS with the request they be ‘fast tracked’ for inclusion in the new code set for 2009. The decision on whether those codes will be part of the 2009 changes will not be known until the Final Rule, expected to be published in the Federal Register in August. Along with the new diagnosis codes more than 40 new procedure codes for inpatient reporting were proposed. All new 2009 ICD-9-CM codes will become effective Oct. 1.

Watch for an upcoming article detailing all the ICD-9-CM 2009 diagnostic code changes in Cutting Edge.

Download a list of proposed changes

Medicare Advantage Plans '08 3.6% Hike
CMS announced that average reimbursements to providers of private Medicare Advantage (MA) plans will increase by 3.6 percent in 2009. The deductible for Medicare prescription drug plans will increase to $295 in 2009 from $275 this year and the initial coverage limit will increase to $2,700 from $2,510.

The 2009 payment rate is not a final payment amount, but rather a standard for which companies offer their services. To help attract new enrollees, companies usually offer to provide Medicare benefits for less than the standard as they use the remaining money to offer extra benefits, such as dental and vision care. More information regarding the payment boost.

Does Heartsbreath Test Need a NCD?
Menssana Research is asking CMS to consider national coverage for the Heartsbreath test for grade 3 heart transplant rejection. The Heartsbreath test is a new, FDA-approved breath test which detects oxidative stress and may predict the probability of grade 3 rejection in heart transplant recipients who received their transplants in the preceding year.

The conventional procedure used in the diagnosis of all grades of heart transplant rejection is endomyocardial biopsy. The device is indicated for use as an adjunct to, and not as a substitute for, endomyocardial biopsy to diagnose grade 3 heart transplant rejection in patients who have received heart transplants within the preceding year.

There is no NCD for the Heartsbreath test at this time.

Find out more.

You can submit comments regarding the NCD for Heartsbreath test between April 10 and May 10, 2008 on the CMS website.

CMS Reconsiders PET Coverage
CMS is reconsidering section 220.6 to end requirements for data collection of all oncologic indications for positron emission tomography (PET) except for monitoring response to treatment.

Currently, section 220.6 of the National Coverage Determination (NCD) Manual establishes the requirement for prospective data collection for FDG PET used in the diagnosis, staging, restaging, and monitoring the response to treatment for brain, cervical, ovarian, pancreatic, small cell lung and testicular cancers, as well as for cancer indications not previously specified in section 220.6 in its entirety.

PET is an imaging procedure for assessing metabolic activity and perfusion in organs or tissues. Through intravenous administration of positron-emitting radioisotopes, images are captured to help determine malignancy based on biologic activity or surrounding tissue. Usually, radioisotope 2-[F18] fluoro-2-deoxy-D-glucose (FDG) is used in the oncologic FDG PET imaging procedures. The rate of FDG decay provides information on glucose metabolism of tissues being studied.

For the current NCD on PET follow the links to section 220.6 and 220.6.14.

CMS Not Changing PTA Coverage
After a year of review, CMS has determined that Medicare coverage of percutaneous transluminal angiograph (PTA) should not change.

This procedure involves inserting a balloon catheter into a narrow or occluded blood vessel to recanalize and dilate the vessel by inflating the balloon. The objective of PTA is to improve the blood flow through the diseased segment of a vessel so that vessel patency is increased and embolization is decreased. With the development and use of balloon angioplasty for treatment of atherosclerotic and other vascular stenoses, PTA (with and without the placement of a stent) is a widely used technique for dilating lesions of peripheral, renal, and coronary arteries.

More on this determination.

MMI is Now Contexo Media®
The Medical Management Institute (MMI) officially has changed its name to Contexo Media®. MMI was acquired by Contexo Media® in June 2006 and the new name now completes the transformation of MMI to Contexo Media®. MMI has provided coding products and education to health care professionals in coding, billing, reimbursement, and compliance.

Contexo Media is a Mindshare sponsor of AAPC.

Test Yourself
Index # EB04022008A

Use this number to document 0.5 CEUs for this EdgeBlast.

By answering the following questions, you can earn 0.5 continuing education units to apply toward your AAPC certification renewal. Simply answer the questions and include the number of the EdgeBlast when submitting your CEUs. The number is available at the top of the page.

1. The Heartsbreath test is a new, FDA-approved breath test which detects:

2. The development and use of balloon angioplasty for treatment of atherosclerotic and other vascular stenoses, PTA (with and without the placement of a stent) is a widely used technique for dilating lesions of:

3. CMS announced that the deductible for the Medicare prescription drug plans will increase from $275 this year to how much in 2009?

4. Which is not a cancer that section 220.6 of the NCD Manual establishes the requirement for prospective data collection for FDG PET used in the diagnosis, staging, restaging, and monitoring the response to treatment for?

5. What is the conventional procedure used in the diagnosis of all grades of heart transplant rejection?

Test Yourself Online
These same questions can be accessed online at www.aapc.com/testyourself/. Once you go there and take the test, you can automatically grade your answers, correct any mistakes and have your CEUs automatically added to your CEU Tracker for submission.

Note: Beginning next month (May), all Test Yourself questions will be accessed online.

The AAPC EdgeBlast is offered as a benefit to members and we hope you find the information useful. If you'd rather not receive future EdgeBlast issues, please log in to our member area and change your e-mail preferences.

AAPC
2233 S Presidents Dr., Suite F | Salt Lake City, UT 84120 | (801) 236-2200


Copyright © 2008 AAPC - All rights reserved. CPC®, CPC-H®, and CPC-P® are registered trademarks of the AAPC.

CPT® codes Copyright 2007 American Medical Association. All Rights Reserved. CPT® is a trademark of the AMA. 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.