(Medicare Claims Processing Manual)

HCPCS codes G0396 and G0397 are to be used for structured alcohol and/or substance (other than tobacco) abuse assessment and intervention services that are distinct from other clinic and emergency department visit services performed during the same encount er.  Hospital resources expended performing services described by HCPCS codes G0396 and G0397 may not be counted as resources for determining the level of a visit service and vice versa (i.e., hospitals may not double count the same facility resources in order to reach a higher level clinic or emergency department visit).  However, alcohol and/or substance structured assessment or intervention services lasting less than 15 minutes should not be reported using these HCPCS codes, but the hospital resources expended should be included in determining the level of the visit service reported.  200.7 - Billing for Cardiac Echocardiography Services (Rev. 1445, Issued:  02- 08-08; Effective:  01 -01-08; Implementation:  03 -10-08)  200.7.1 - Cardiac Echocardiography Without Contrast  (Rev. 1445, Issued:  02- 08-08; Effective:  01 -01-08; Implementation:  03 -10-08)  Hospitals are instructed to bill for echocardiograms without contrast in accordance with the CPT code descriptors and guidelines associated with the applicable Level I CPT code(s) (93303- 93350).   200.7.2 - Cardiac Echocardiography With Contrast  (Rev. 1657, Issued: 12- 31-08, Effective: 01 -01-09, Implementation: 01- 05-09)  Hospitals are instructed to bill for echocardiograms with contrast using the applicable HCPCS code(s) included in Table 200.7.2 below.  Hospitals should also report the appropriate units of the HCPCS codes for the contrast agents used in the performance of  the echocardiograms.  Table 200.7.2 -  HCPCS Codes For  Echocardiograms With Contrast   HCPCS  Long Descriptor  C8921 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; complete  C8922 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; follow -up or limited study C8923 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real -time with image documentation (2D), includes M -mode recording, when performed, complete, without spectral or color Doppler echocardiography C8924 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real -time with image documentation (2D), includes M -mode recording, when performed, follow -up or limited study  C8925 Transesophageal echocardiography (TEE) with contrast, or without contrast followed by with contrast, real time with image documentation (2D) (with or without M -mode recording); including probe placement, image acquisition, interpretation and report   HCPCS  Long Descriptor  C8926 Transesophageal echocardiography (TEE) with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report  C8927 Transesophageal echocardiography (TEE) with contrast, or without contrast followed by with contrast, for monitoring purposes, including probe placement, real time 2- dimensional image acquisition and interpretation leading to ongoing (continuous) assessment  of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis  C8928 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real -time with image documentation (2D), includes M -mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report  C8929 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real -time with image documentation (2D), includes M -mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler e chocardiography C8930 Transthoracic echocardiography, with contrast, or without contrast followed by with contrast, real -time with image documentation (2D), includes M -mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with physician supervision   200.8 - Billing for Nuclear Medicine Procedures  (Rev. 1657, Issued: 12- 31-08, Effective: 01 -01-09, Implementation: 01 -05-09)  Beginning January 1, 2008, the I/OCE began editing for the presence of a radiolabeled product when a separately payable nuclear medicine procedure is present on a claim.  Hospitals should include radiolabeled product HCPCS codes on the same claim as a nuclear medicine procedure beginning on January 1, 2008.  Hospitals are required to submit the HCPCS code for the radiolabeled product on the same claim as the HCPCS code for the nuclear medicine procedure.  Hospitals are also instructed to submit the claim so that the services on the claim each reflect the date the particular service was provided.  Therefore, if the nuclear medicine procedure is provided on a different date of service from the radiolabeled product, the claim will contain more than one date of service.  More information regarding these edits is availa ble on the OPPS Web site at http://www.cms.hhs.gov/HospitalOutpatientPPS/ .  Hospitals are instructed to use HCPCS code C9898 (Radiolabeled product provided during a hospital inpatient stay) on outpatient claims for nuclear medicine procedures to indicate that a radiolabeled product that provides the radioactivity necessary for the  reported diagnostic nuclear medicine procedure was provided during a hospital inpatient stay.  This HCPCS code is assigned status indicator N because no separate payment is made for the code under the OPPS.  The effective date of the code is January 1, 2008, the date the nuclear medicine procedure- to-radiolabeled product edits were initially implemented.  Because the Medicare claims processing system requires that there be a charge for each HCPCS code reported on the claim, hospitals should always report  a token charge of less than $1.01 for HCPCS code C9898.  The date of service reported on the claim for HCPCS code C9898 should be the same as the date of service for the nuclear medicine procedure HCPCS code, which should always accompany the reporting of HCPCS code C9898.  HCPCS code C9898 should never be reported on a claim without a diagnostic nuclear medicine procedure that is subject to the nuclear medicine procedure -to-radiolabeled product edits.  More information regarding these edits is available on the OPPS Web site at http://www.cms.hhs.gov/HospitalOutpatientPPS   Future updates to this section will be communicated in a Recurring Update Notification.   200.9 - Billing for Sometimes Therapy Services that May be Paid as Non-Therapy Services for Hospital Outpatients  (Rev. 3156, Issued: 12 -22-14, Effective: 01 -01-15, Implementation: 01- 05-15)  Section 1834(k) of the Act, as added by Section 4541 of the BBA, allows payment at 80 percent of the lesser of the actual charge for the services or the applicable fee schedule amount for all outpatient therapy services; that is, physical therapy services, speech -language pathology services, and occupational therapy services.  As provided under Section 1834(k)(5) of the Act, a therapy code list was created based on a uniform coding system (that is, the HCPCS) to identify and track these outpatient therapy s ervices paid under the Medicare Physician Fee Schedule (MPFS).   The list of therapy codes, along with their respective designation, can be found on the CMS Website, specifically at http://www.cms.hhs.gov/TherapyServices/05_Annual_Therapy_Update.asp#TopOfPage .  Two of the designations that are used for therapy services are: always therapy and sometimes therapy.  An always therapy service must be performed by a qualified therapist under a certified therapy plan of care, and a sometimes therapy service m ay be performed by physician or a non- physician practitioner outside of a certified therapy plan of care.   Under the OPPS, separate payment is provided for certain services designated as sometimes therapy services if these services are furnished to hospital outpatients as a non-therapy service, that is, without a certified therapy plan of care. Specifically, to be paid under the OPPS for a non- therapy service, hospitals SHOULD NOT append the therapy modifier GP (physical therapy), GO (occupational therapy), or GN (speech language pathology), or report a therapy revenue code 042x, 043x, or 044x in association with the sometimes therapy codes listed in the table below.   To receive payment under the MPFS, when sometimes therapy services are performed by a qualified therapist under a certified therapy plan of care, providers should append the appropriate therapy modifier GP, GO, or GN, and report the charges under an appropriate therapy revenue code, specifically 042x, 043x, or 044x. This instruction does not apply to claims for sometimes therapy codes furnished as non- therapy services in the hospital outpatient department and paid under the OPPS.   Effective January 1, 2015, two HCPCS codes designated as Sometimes Therapy services, G0456 (Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically -powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimeters) and G0457 (Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically -powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area greater than 50 square centimeters) would be terminated and replaced with two new CPT codes 97607 (Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non- durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session;  total wounds(s) surface area less than or equal to 50 square centimeters) and 97608 (Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non- durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session;  total wounds(s) surface area greater than 50 squa re centimeters).