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News You Can Use: Earn Reimbursement for New C Codes

April OPPS offers an array of coding, policy changes                                                            

You can anticipate payment for a wider variety of hospital outpatient prospective payment system (OPPS) claims - and a lot of policy changes.                                                                                   
In an April 8 Medlearn Matters article, the CMS released a laundry list of payment changes for the OPPS April 2005 update. Now you can get reimbursement under OPPS using these new codes:

  C9723 (Dynamic infrared blood perfusion imaging) and C9724 (Endoscopic full-thickness plication in the gastric cardia using endoscopic plication system; includes endoscopy).

  Q4079 (Injection, Natalizumab, 1 mg) with status indicator "G", instead of  C9126.

  C9223 (Injection, adenosine  for therapeutic or diagnostic use, 6 mg, not to be used to report any adenosine phosphate compounds, instead use A9270) instead of J0150 and J0152.

  J9390 for generic (Vinorelbine tartrate, per 10 mg) and C9440 for the brand name. 

  C9127 (Injection, paclitaxel protein-bound particles, per 1 mg) and C9128 (Injection, pegaptamib sodium, per 0.3 mg).
Important: Pay attention to these payment changes:

Look for the new status indicator "M" for services not billable to fiscal intermediaries (FIs) or payable under the OPPS.

Venipuncture code G0001 was deleted for services on or before Jan. 1. Use 36415 (Collection of venous blood by venipuncture) and 36416 (Collection of capillary blood specimen [e.g., finger, heel, ear stick]).

OPPS reactivated modifier -27 (Multiple outpatient hospital E/M encounters on the same date), effective Jan. 1. For services provided between Jan. 1 and March 31, you can submit an adjustment bill to receive payment for services related to modifier -27.
To read the entire Medlearn Matters article, go to .
Medicare needs your input on National Coverage Determinations

Give CMS your opinions on how it should weigh evidence in deciding whether to cover an item or service. On April 7, the agency issued draft guidance to improve Medicare's National Coverage Determination (NCD) process using a new policy, called coverage with evidence development (CED).

CMS will use the CED policy when a medical intervention lacks conclusive data supporting positive health outcomes or when sufficient data support a medical intervention's effectiveness but not medical necessity. CED could also answer questions about a medical intervention's safety, as well as risks and benefits to the Medicare patient demographic.
Watch for: CMS will hold an open-door forum on May 9 for public comment on many CED questions, such as:

  In what circumstances could a CED initiative be useful?

  What process should CMS use to decide when and how to apply CED?

  What study designs or evidence development methods should CMS use?

  How should CMS apply a study design and implementation process?
Opportunity: You can submit feedback online to caginquiries@cms.hhs.gov. The deadline for comment submissions is June 5.

- Published on 2005-05-17