Medicare to introduce revisions to Chapters 13, 18, and 32 in its Claims Processing Manual as of October 29th, 2021.
In an effort to update current coding guidelines, the CMS has made several adjustments in its Claims Processing Manual. Namely, chapters 13, 18, and 32 have been updated. These three chapters now contain revised information related to radiology services and other diagnostic procedures, preventive & screening services, as well as to special services, such as ambulatory blood pressure monitoring. Read along to stay up to date with the current processing manual!
The Centers for Medicare & Medicaid Services has revised chapters 13, 18, and 32 in the Claims Processing Manual with the implementation date of October 29th, 2021. The Claim Processing Manual contains guidelines related to a proper coding of diagnoses and procedure codes reported on various patients. The chapters that are included in this revision focus on radiology, diagnostic procedures, special services, and preventive services. The revision is effective for all the services performed on or after October 29th, 2021.
Chapter 13 is dedicated to radiology and other diagnostic procedures. However, a revision has affected only particular services.
First, the CMS has expanded a list of potential diagnosis codes that are required to be reported when billing positron emission tomography (PET) scans for Alzheimer’s disease. As per the revision, at least one of the following ICD-10 codes need to be reported in such cases: F03.90 (Unspecified dementia without behavioral disturbance), F03.90 plus F05 (Delirium due to known physiological condition), G30.9 (Alzheimer's disease, unspecified), G31.01 (Pick's disease), G31.9 (Degenerative disease of the nervous system, unspecified), R41.2 or R41.3 (retrograde and another amnesia, respectively). At the same time, providers are allowed to report all other codes mentioned in section 60.3.1 of the mentioned Manual for dementia and neurodegenerative diseases.
Second, the revision had introduced an updated list of diagnoses that now need to be reported along with Z00.6 (Encounter for examination for normal comparison and control in clinical research program) when submitting a claim for a Beta Amyloid PET scan in Dementia and Neurodegenerative Disease. Below is a complete list of diagnosis codes and their definitions that now need to be shown on a claim:
To sum up, the following needs to be documented:
- Condition code 30, and value code D4 (A/B MAC (A) only)
- Modifier Q0 as appropriate (if applicable)
• Z00.6 (in either the primary/secondary position)
• A PET HCPCS/CPT code (78811 or 78814)
• One of the diagnosis codes mentioned in the table above.
Chapter 18th covers preventive and screening services. In accordance with the new revision, some changes are to be implemented for the Papanicolaou test (PAP smear test). Specifically, the CMS has expanded the list of diagnosis codes that can be used to indicate a high risk of PAP every year, and a low risk every two years. A full list of diagnosis codes can be found here. However, just like in an update introduced for the 13th chapter, additional conditions now need to be documented. At least one of the following diagnosis codes is required: Z01.411, Z01.419 (Encounter for gynecological examination (general) (routine) with (out) abnormal findings); Z12.4, Z12.72, Z12.79, and Z12.89 (Encounter for screening for malignant neoplasms) or the “high-risk” diagnosis codes:
Also, the HCPCS code G0476 (Cervical cancer screening) is now required to be billed alongside the following ICD-10 codes: Z11.51 (encounter for screening for HPV), and Z01.411 (encounter for a gynecological exam (general) (routine) with abnormal findings), Z01.419 (encounter for a gynecological exam (general) (routine) without abnormal findings).
Chapter 32 determines the billing guidelines for special services. The current revision has introduced a variety of new changes related to ambulatory blood pressure monitoring (ABPM), as well as to hyperbaric oxygen therapy used to treat diabetic wounds.
Effective October 29th, 2021, ABPM procedure codes may only be billed when the ICD-10 R03.0 (Elevated blood pressure reading, without a diagnosis of hypertension) is reported on the claim. In addition, hospital outpatient departments may now bill the HCPCS code G0277 (Hyperbaric oxygen under pressure, full body chamber, per 30-minute interval) alongside 99183 (Physician attendance and supervision of hyperbaric oxygen therapy, per session).