PARA Weekly Update For Users Grayscale Version 4-4-2018

Date

PARA WEEKLY CODING FOR HPV SCREENING

UPDATE For Users

Improving T he Businessof HealthCare Since 1985 April 4, 2018 NEWS FOR HEALTHCARE DECISION MAKERS

IN THIS ISSUE QUESTIONS & ANSWERS - Newborn Observation - Hypertensive Cardiovascular Disease - Continuous Glucose Monitoring - 76642 Bilateral Ultrasound - Hospice Room And Board - Anti-Coagulant Clinics And MTM OPPS & HCPCS UPDATE APRIL 1, 2018 CMS COVERAGE UPDATE: SCREENING FOR LUNG CANCER WITH LOW DOSE CT NEW CHROME VERSION OF PDE AND OTHER BROWSER FORMATS

PARA COMPANY NEWS ABOUT PARA SERVICES CONTACT US

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The number of new or revised Med Learn (MLN Matters) articles released this week. All new and previous Med Learn articles can be viewed under the type "Med Learn", in the Advisor tab of the PARA Dat a Edit or . Click here.

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The number of new or revised Transmittals released this week. All new and previous Transmittals can be viewed under the type "Transmittals" in the Advisor tab of the PARA Dat a Edit or . Click here.

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FAST LINKS: Click on the link for special areas of interest:

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Administration: Pages 1-40 HIM/Coding Staff: Pages 1-40 Obstetrics: Page 2 Providers: Pages 2-3,5,7,9,15,25,31 Diabetes Care: Page 5 Imaging Services: Pages 7,15

- Hospice Care: Page 8 - Pharmacy Services: Pages 9,25,32,33,37 - PDE Users: Pages 11,22 - Finance Dept: Pages 26,28,34,36,38 - SNF: Pages 27,29,35

© PARA Healt h Car e An alyt ics ®

CPT is a r egist er ed t r adem ar k of t h e Am er ican M edical Associat ion

PARA Weekly Update: April 4, 2018

NEWBORN OBSERVATION

Question: What is the appropriate ICD-10 CM code(s) to report newborn treated prophylactically due to GBS+ mother?

Scenario: Newborn delivered via NSVD to GBS+ mother who did not receive prophylactic antibiotics prior to delivery due to precipitous delivery. Per recommendation of ID, newborn had to receive antibiotic therapy after delivery via multiple IM injections of two antibiotics and blood cultures were negative.

Answer: Report ICD-10 CM code Z05.1 Observation and evaluation of newborn for suspected infectious condition ruled out. ICD-10 CM P00.2, Newborn affected by maternal infectious disease would not be appropriate in this case, since the newborn is being treated prophylactically. As stated in Coding Clinic 2016 4th Qtr, ?The phrase "(suspected to be)" has been deleted from all code titles in categories P00, P01, P02, P03 and P04. Z05, Encounter for observation and evaluation of newborn for suspected diseases and conditions ruled out should be reported?. Please refer to the AHA Coding Clinic 2016 4th Qtr reference and PARA Data Editor Code Description.

ICD-10-CM New/Revised Codes: Newborn Affected by Maternal Factors and by Complications of Pregnancy, Labor and Delivery Coding Clinic, Fourth Quarter 2016: Page 54 The application of categories P00-P04, Newborn affected by maternal factors and by complications of pregnancy, labor and delivery, has been revised. The introductory note has been revised as follows: Note: These codes are for use when the listed maternal conditions are specified as the cause of confirmed morbidity or potential morbidity which have their origin in the perinatal period (before birth through the first 28 days after birth). The phrase "(suspected to be)" has been deleted from all code titles in categories P00, P01, P02, P03 and P04. Concurrently, 14 new codes have been created at category Z05, Encounter for observation and evaluation of newborn for suspected diseases and conditions ruled out.

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PARA Weekly Update: April 4, 2018

HYPERTENSIVE CARDIOVASCULAR DISEASE

Question: Hypertension and Heart disease have a presumed causal relationship in ICD-10 CM effective October 1, 2016. What types of heart disease are included in this causal relationship with hypertension in ICD-10 CM? Answer: Heart conditions classified to ICD-10 CM Category I50.- or I51.4-I51.9 are included in the ICD-10 CM causal relationship when hypertension is additionally documented. Code category I11, Hypertensive heart disease revised the ?Includes note? to include code I50.- effective October 1, 2017. ?Includes notes? in ICD-10 CM indicate the terminology following the main term in the tabular index are synonyms of the main condition description.

Please refer to the 2017/ 18 Official Coding Guidelines Section I.A.10 which defines includes notes and inclusion terms and how to identify they them in the code set. An additional code for the type of heart disease should be coded as stated in the ICD-10 CM tabular index. Please refer to the PARA Data Editor Code descriptions for heart disease (I50.- and I51.4- I51.9). Please refer to the 2017/ 18 ICD-10 CM Official Coding Guidelines located in the PARA Data Editor Calculator.

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PARA Weekly Update: April 4, 2018

HYPERTENSIVE CARDIOVASCULAR DISEASE

2017/18 ICD-10 CM Official Coding Guidelines: Section I.C.9. a.1. ? Hypertensive Cardiovascular Disease Hypertension with heart conditions classified to I50.- or I51.4-I51.9, are assigned to a code from category I11, Hypertensive heart disease. The same heart conditions with hypertension are coded separately if the provider has specifically documented a different cause. Sequence according to the circumstances of the admission/encounter. The same heart conditions (I50.-, I51.4-I51.9) with hypertension are coded separately if the provider has specifically documented a different cause.

Sequence according to the circumstances of the admission/encounter.

2017/18 ICD-10 CM Official Coding Guidelines: Section I.A.17. - Conventions, general coding guidelines and chapter specific guidelines: Inclusion terms: The conventions, general guidelines and chapter-specific guidelines are applicable to all health care settings unless otherwise indicated. The conventions and instructions of the classification take precedence over guidelines.

A ?code also? note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction.

2017/18 ICD-10 CM Official Coding Guidelines: Section I.A.11. - Conventions, general coding guidelines and chapter specific guidelines: Inclusion terms: List of terms is included under some codes. These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of ?other specified? codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.

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PARA Weekly Update: April 4, 2018

CONTINUOUS GLUCOSE MONITORING

Question: The code 95250 (Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; physician or other qualified health care professional (office) provided equipment, sensor placement, hook-up, calibration of monitor, patient training, removal of sensor, and printout of recording) includes the removal so I want to ensure I am giving the proper information.

Due to simplified technology and recent Medicare approval, our Diabetes Educator now see many patients to apply, and then two weeks later remove, a Continuous Glucose Monitor (CGM). This influx has resulted in some billing questions. Here is what is happening: - When CGM is applied code 95250 is used - When CGM is removed, ?no charge? is indicated. This educators state that they do this because they think the MD will use the code 95251 (for removal and download) when the results are read and discussed with the patient.

- Some patients remove the CGM themselves and drop it off to be downloaded, so there is no actual visit or coding for removal.

- Occasionally, in conjunction with CGM, the educators provide significant Diabetes Education as part of our DSME program and they use code G0108 Questions: - It was my understanding that the nurses should use both the apply and remove codes, 95250 & 95251. Is it a problem that they are only using the first code?

- This is a simple nursing procedure. Should there be a co-pay?

- Can the CGM and DSME codes be used in the same visit? If yes, then the co-pay applies, correct?

- Lastly, can you tell me about the reimbursement for this? I am concerned that it may not be a good use of time for the Diabetes Educators and I would like to understand how it impacts their revenue. It is actually in the scope of the MA, but not happening at that level yet.

Answers: Should nurses report both the apply and remove codes, 95250 & 95251? -- The HCPCS 95251 for the interpretation and report must be billed by a qualified healthcare practitioner acting within the state scope of practice laws appropriate to their licensure. Therefore, an RN/ LPN would not bill for 95251, the claim must report a ?qualified? rendering provider; only a qualified healthcare practitioner (MD/ DO/ ARNP/ PA) can claim reimbursement for 95251.

On the other hand, a facility may bill for 95250 ? that code is not restricted to only ?qualified healthcare professional? billing.

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PARA Weekly Update: April 4, 2018

CONTINUOUS GLUCOSE MONITORING

Is there a co-pay for this service? There is a coinsurance obligation under Medicare for 95250; the minimum copay is $26.53 if billed by a hospital; if billed by a physician clinic, the coinsurance would be 20% of the pro fee reimbursement rate of $172.71 = $34.54.

Can the CGM and DSME codes be used in the same visit? Both G0108 and 95250 may be billed on the same day, there is no CCI edit for either physician or facility fee billing:

Is there any effect on the coinsurance if both 95250 and G0108 are billed together? No, there would be no effect on the coinsurance assigned to patient liability due to billing the two services together on the same day.

What is the rate of reimbursement for this service? Physician clinics are reimbursed for 95250 at an allowable rate of $172.72 under Medicare?s physician fee schedule. Facilities are paid an allowable rate of $132.64 under OPPS.

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PARA Weekly Update: April 4, 2018

76642 BILATERAL ULTRASOUND

Question: Our patient had 76642 LT and RT and was charged $553.00. Our patient also received an estimate from another hospital, so we called that facility and was told that the price would be $373.00 and that price included one or two ultrasounds. The CPTÂŽ code reads that 76642 only once per breast, per session.

Please advise if we are charging appropriately by charging two separate ultrasounds, 76642LT and 76642RT. Answer: You can charge 76642 2x per encounter where the MUE is currently set. As you have already noted, the HCPCS 76642 is unilateral. The hospital may charge separately for each ultrasound of the breast, either by billing one unit with modifier 50 appended to the HCPCS, or with two units on one line, or billing two lines of one unit each with the RT modifier on one and the LT on the other. Certain payers may have a preference in how bilateral services are reported.

Here is the bilateral indicator description assigned to this code when paid under the Medicare Physician Fee Schedule (i.e. at a private clinic.)

We note that additional time is spent in the radiology suite performing the second exam, therefore it stands to reason that there would be an additional charge for the second procedure.

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PARA Weekly Update: April 4, 2018

HOSPICE ROOM AND BOARD

Question: 1. When hospice services are given, is it appropriate to charge a Room and Board charge for Hospice? This would not be in addition to any other Room and Board charge when patient is in hospice status.

2. When a patient is on the Skilled Caring Unit and then becomes a "non Skilled" patient, is it appropriate to charge a Room and Board charge for this? This would not be in addition to any other Room and Board charge. These types of patients may be one that have no family members around and are waiting on a nursing home placement, for example.

Answer: To respond to the question on Hospice, it depends on which services were rendered. For example, whether the patient was eligible and had elected hospice (e.g. certificate of terminal illness on file and beneficiary consent), and whether the patient spent the night in hospice care.

Regarding the ?non-skilled? patient status question, most facilities which accommodate non-skilled patients charge a daily residential room and board rate. Since Medicare does not cover non-skilled nursing care, a ?Hospital Issued Notice of Non-Coverage? (HINN) should be provided to Medicare beneficiaries on the day of status change from skilled to non-skilled to inform the patient that Medicare coverage for the stay has ended, and the patient is personally liable for charges incurred from that point forward.

Here is a link to more information about HINN with an important caveat: https:/ / www.cms.gov/ Medicare/ Medicare-General-Information/ BNI/ HINNs.html

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PARA Weekly Update: April 4, 2018

ANTI-COAGULANT CLINICS AND MTM

Question: We previously discussed about charging for services of pharmacists in providing medication counseling and oversight for patients who are on anticoagulation medication with visit charge G0463, and it was published in 02/ 14/ 18 the PARA Weekly Update. So, does that mean hospital cannot bill for both on campus and off campus anticoagulation clinic visits with G0463?

Can you also advise on MTM billing?

Answer: Our recommendation in the paper on billing for anticoagulation clinic visits holds true for both on-campus and off-campus hospital locations. Unless the patient saw a ?qualified healthcare Practitioner? (MD/ DO/ ARNP/ PA) for a medically necessary service over and above the PT/ INR testing, the E/ M visit code G0463 is not reportable.

Anti-coagulation clinic services may meet E/ M requirements when assessment and management by a physician or non-physician practitioner is documented. The documentation of such a visit should support medical necessity.

In other words, it should document the pertinent history, examination, dietary counseling and or re-education; evaluation of patient complaints of abnormal bruising or bleeding, etc., and a change in dosage of the patient?s anticoagulation medication.

We are assuming that your acronym of "MTM" means Medication Therapy Management. If correct, then our paper on billing for the pharmacist?s services may provide the information you need. Here is the excerpt: Question: Our hospital would like to charge for the services of our pharmacists in providing medication counseling and oversight for patients with complex chronic conditions.

Can we charge a visit charge, such as G0463 - hospital outpatient clinic visit for assessment and management of a patient.

Answer: PARA does not recommend billing for outpatient hospital visits for clinical services performed by pharmacists. We do not question the value of the service, we simply find that it does not meet the standard of a reimbursable service under Medicare rules.

We are not aware of any facilities that submit claims for outpatient evaluation and management services performed by pharmacists. That being said, a pharmacist may provide services in a ?freestanding? (not provider-based) clinic under the ?incident to? billing rules. In a non-facility (clinic) setting, it is permissible to report the services of a pharmacist under the NPI of a physician who was primarily responsible for the care of the patient seen on the date of service, provided that all of the following criteria are met: 1. Any services performed by the pharmacist are within the State Scope of Practice laws applicable to the pharmacist?s licensure; 2. The physician or the organization billing for the physician?s services must incur an expense for the services provided by the pharmacist (and billed under the physician?s NPI); 3. The patient must be an established patient, and the diagnosis being treated is not new; 4. The pharmacist?s services are in keeping with the treatment plan established by the physician for that particular patient; 5. The physician whose NPI will be reported as the rendering provider is in the clinic and immediately accessible during the time the service is provided; 9

PARA Weekly Update: April 4, 2018

ANTI-COAGULANT CLINICS AND MTM

6. The physician reported as the rendering provider reviews the progress note after the ?incident to? service, optimally adding a signature to the note to indicate s/he continues active involvement in the care of the patient.

The American Society of Hospital Pharmacists (ASHP) offers an FAQ on its website addressing billing a pharmacist ?incident to? a physician in a non-hospital based clinic.

Here?s a link and an excerpt: https://www.ashp.org/-/media/assets/ambulatory-care-practitioner/docs/sacp-pharmacist-billingfor-ambulatory-pharmacy-patient-care-services.pdf

?For Medicare patients, hospital-based outpatient services (including clinics) are governed by the Hospital Outpatient Prospective Payment System (HOPPS) regulations. However, physician offices and physician-based clinics providing services for Medicare patients are not governed by HOPPS, but instead are governed by a number of CMS rulings that can be found at http://www.cms.gov/Regulations-and-Guidance/Regulations-and-Guidance.html This site includes the Medicare Benefit Policy Manual which describes who can bill under Medicare Part B and the 1995 and 1997 Documentation Guidelines for Evaluation and Management Services which describes the documentation required for billing. ?The Medicare Benefit Policy Manual describes which providers may bill under Medicare Part B. Pharmacists are not recognized Medicare Part B providers except when providing immunizations.

The Medicare Benefit Policy Manual, Chapter 15 Section 601 describes physician delegation to others working in their offices who provide care to Medicare patients and a mechanism for billing such services. The title of this Chapter is ?Services and Supplies Furnished Incident to a Physician?s/NPP?s Professional Service? and governs the services pharmacists provide in a non-institutional setting. ?These services are often termed ?incident to.?

Under these rules, pharmacists can bill for their services in a physician-based clinic. These rules differ in their processes from the HOPPS regulations. ?Non-institutional physician-based offices and clinics may negotiate specific contracts with private payers that may include a different mechanism for payment to enable pharmacist reimbursement for patient care services, 2 including utilizing a direct payment process incorporating the Medication Therapy Management (MTM) CPTÂŽ codes or another preferred mechanism.2, 3, 4 Alternatively, pharmacist-based services may be folded into a capitated payment model and or associated with pay for performance incentives."

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PARA Weekly Update: April 4, 2018

OPPS & HCPCS UPDATE APRIL 1 2018

Medicare has released the HCPCS update effective for dates of service on or after April 1, 2018. The changes pertain to reporting biosimilar infliximab. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/MM10454.pdf Effective for services as of April 1, 2018, The April 2018 HCPCS file includes these revised/new HCPCS codes: HCPCS Code: Q5101 - Short Description: Injection, zarxio - Long Description: Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram HCPCS Code: Q5103 - Short Description: Injection, inflectra - Long Description: Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg - Type of Service (TOS) Code: 1,P - Medicare Physician Fee Schedule Database (MPFSDB) Status Indicator: E HCPCS Code: Q5104 - Short Description: Injection, renflexis - Long Description: Injection, infliximab-abda, biosimilar, (renflexis), 10 mg - TOS Code: 1, P - MPFSDB Status Indicator: E HCPCS Code: Q2041 - Short Description: Axicabtagene ciloleucel car+ - Long Description: Axicabtagene Ciloleucel, up to 200 million autologous Anti-CD19 CAR T Cells, Including leukapheresis and dose preparation procedures, per infusion - TOS Code: 1 - MPFSDB Status Indicator: E Effective for claims with dates of service on or after April 1, 2018, HCPCS code Q5102 (which describes both currently available versions of infliximab biosimilars) will be replaced with two codes, Q5103 and Q5104. Thus, Q5102 Injection, infliximab, biosimilar, 10 mg, will be discontinued, effective March 31, 2018.

Also, beginning on April 1, 2018, modifiers that describe the manufacturer of a biosimilar product (for example, ZA, ZB and ZC) will no longer be required on Medicare claims for HCPCS codes for biosimilars. However, please note that HCPCS code Q5102 and the requirement to use biosimilar modifiers remain in effect for dates of service prior to April 1, 2018.

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PARA Weekly Update: April 4, 2018

OPPS & HCPCS UPDATE APRIL 1 2018

In other news, the OPPS Update for April 1 2018 was also published in the following MedLearn: https://www.cms.gov/Outreach-and-Education/ Medicare-Learning-Network-MLN/MLNMattersArticles/ downloads/MM10515.pdf

The update informs of the following changes: One New Separately Payable Procedure Code was added.

One skin substitute product was reassigned from the Low Cost Group to the High Cost Group.

Laboratory HCPCS: Effective January 1, 2018, Medicare has acknowledged one new Multianalyte Assays with Algorithmic Analyses (MAAA) code (0011M), eleven new PLA CPT® codes(specifically, CPT® codes 0024U through 0034U) and deleted two PLA codes (CPT® codes 0004U and 0015U). These updates were made too late in the year to be published in the January 1, 2018 OPPS Update.

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PARA Weekly Update: April 4, 2018

OPPS & HCPCS UPDATE APRIL 1 2018

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PARA Weekly Update: April 4, 2018

OPPS & HCPCS UPDATE APRIL 1 2018

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PARA Weekly Update: April 4, 2018

CMS COVERAGE UPDATE: SCREENING FOR LUNG CANCER WITH LOW DOSE CT Effective January 04, 2016, CMS implemented Medicare coverage of Screening for Lung Cancer with Low Dose Computed Tomography (LDCT). The coverage was added to ?Preventive Services? through the NCD process. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2015-Transmittals-Items /R185NCD.html?DLPage=1&DLEntries=10&DLFilter=MM9246&DLSort=1&DLSortDir=ascending

Further, CMS has approved the American College of Radiology as a registry. Please see elsewhere in this article for updates related to the registry process. https://www.cms.gov/Newsroom/ MediaReleaseDatabase/Pressreleases/2015-Press-releasesitems/2015-02-05.html

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PARA Weekly Update: April 4, 2018

CMS COVERAGE UPDATE: SCREENING FOR LUNG CANCER WITH LOW DOSE CT Coding Claims For LDCT Services: Effective for claims beginning with dates of service February 05, 2016, the following HCPCS G0296 and G0297 have been established by CMS for providers to report LDCT services:

Medicare coinsurance and Part B deductibles are waived for this preventive service.

Claims for LDCT services must be also be billed with the following ICD-10 diagnosis code:

Institutional Billing Requirements: Following implementation of the policy, effective February 05, 2016, providers are required to use the following bill types when reporting LDCT services: 1. G0296 and G0297: 12X, 13X,22X,23X,71X 2. G0296 only: 77X and 85X Medicare will pay for these services as follows: 1. Outpatient hospital departments (OPPS) ? bill types 12X and 13X 2. Skilled nursing facilities (SNFs) ? bill types 22X and 23X (reimbursement based on Medicare Physician Fee Schedule (MPFS) 3. Critical Access Hospitals (CAHs) ? bill types 85X ? reimbursement based on reasonable cost 16

PARA Weekly Update: April 4, 2018

CMS COVERAGE UPDATE: SCREENING FOR LUNG CANCER WITH LOW DOSE CT 4. CAH Method II ? bill types 85X with revenue codes 096X,097X or 098X, reimbursement will be based on the lesser of the actual charge or the MPFS (115% of the lesser of the fee schedule amount and submitted charge) for HCPCS G0296 only 5. Rural Health Clinics (RHCs) ? TOB 71X ? reimbursement is based on the all-inclusive rate for HCPCS G0296 only 6. Federally Qualified Health Centers (FQHCs) ? TOB 77X ? reimbursement is based on the PPS rate for HCPCS G0296 only For all LDCT procedures, criteria must be met fully to enable providers to obtain CMS reimbursement.

CMS criteria for beneficiary eligibility All criteria points outlined below by CMS must be met for this service to be reimbursed by Medicare coverage policies as a preventive service benefit ?

- Beneficiary must be between the ages of 55 ? 77 years and - Must be asymptomatic (no signs or symptoms of lung cancer) and - Abuse of tobacco smoking history of at least 30 pack-years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes) and - Beneficiary must be a current smoker or one that has quit within the last 15 years and - Beneficiary presents with a written order specifically for LDCT that meets the following requirements - Initial LDCT lung cancer screening service: the beneficiary must receive the written order for the LDCT during a lung cancer screening counseling and shared decision-making visit and - The visit must be furnished by a physician or qualified non-physician practitioner (NPP = physician assistant, nurse practitioner or clinical nurse specialist) and - The lung cancer screening counseling and shared decision-making visit must include the following elements and must be documented in the patient?s medical records and - Determination of beneficiary eligibility that includes mention of previous eligibility requirements (patient age, asymptomatic, calculation of cigarette smoking pack-years and if a current or former smoker the number of years since quitting and - In the shared decision making, the process should include the use of one or more decision aids, include benefits and harms of screening, follow-up diagnostic testing, over-diagnosis, false positive rate and total radiation exposure and

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PARA Weekly Update: April 4, 2018

CMS COVERAGE UPDATE: SCREENING FOR LUNG CANCER WITH LOW DOSE CT - The counseling includes the importance of continuing with annual lung cancer LDCT screening, how comorbidities impact and the ability or willingness of the beneficiary to undergo diagnosis and treatment and - A portion of the counseling should also include the importance of maintaining cigarette smoking abstinence if beneficiary is a former smoker, or the importance of smoking cessation if the beneficiary is a current smoker and - Furnishing information about tobacco cessation interventions and - The furnishing of a written order for lung cancer screening with LDCT - Subsequent LDCT lung cancer screening service: the beneficiary must receive the written order for the LDCT during a lung cancer screening counseling and shared decision-making visit. If a physician or NPP elects to provide subsequent lung cancer screening counseling and shared decision-making visit, the visit must meet all criteria as described above for the Initial visit - Written orders are required for both Initial and Subsequent LDCT lung cancer screenings and must be documented in the beneficiary?s medical records. This documentation is -

Beneficiary date of birth Actual pack-year smoking history (number) Current smoking status and or if former smoking, number of years since quitting Statement that the beneficiary is asymptomatic National Provider Identifier (NPI) of the ordering practitioner

Eligibility criteria for reading radiologist A radiologist that performs the reading and interpretation report for a lung cancer screening LDCT must have the following skill set to meet eligibility requirements.

- Hold a valid Board certification or board eligibility with the American Board of Radiology or any equivalent organization and - Have a documented training record in diagnostic radiology and radiation safety and - Be involved or have involvement in the supervision and interpretation of at least 300 chest computed tomography acquisitions in the past 3 years and - Documented participation in continuing medical education according to current American College Radiology standards and - Furnish lung cancer screening with LDCT in a radiology imaging facility that meets CMS eligibility criteria (listed in the next section of this document) 18

PARA Weekly Update: April 4, 2018

CMS COVERAGE UPDATE: SCREENING FOR LUNG CANCER WITH LOW DOSE CT Eligibility Criteria For A Radiology Imaging Facility That Performs LDCT Lung Cancer Screenings - Must be able to perform LDCT with volumetric CT dose index (CTDIvol) of <3.0 mGy (milligray) for standard size patients (this is to be defined as those 5?7? in height and weight approximately 155lbs) with appropriate reductions in CTDIvol for small patient and appropriate increases in CTDIvol for larger patients and - Able to utilize a standardized lung nodule identification, classification and reporting system and - Has available smoking cessation interventions for current smokers and - Collects and submits data to a CMS-approved registry for each LDCT Lung Cancer screening performed. The data collected and submitted to a CMS-approved registry must include the following elements, at the minimum.

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PARA Weekly Update: April 4, 2018

CMS COVERAGE UPDATE: SCREENING FOR LUNG CANCER WITH LOW DOSE CT All CMS-approved registries must be able to have the capacity and capability to collect data from any Medicare-eligible imaging facility/ department that performs lung cancer screening with LDCT, with a catchment area that includes all 50 states, United State Territories and District of Columbia. CMS will evaluate each entity that is interested in becoming a CMS-approved registry for their capability in meeting the registry and data collection requirements that are outlined below in this national coverage determination (NCD).

- Have established a steering committee and a govemance board for oversight of registry - Have a complete registry management plan that includes identification of key personnel - Have an operational plan and work frame that describes the mechanisms in place for collection and submission of data between the imaging facilities and the registry - Registry catchment area - Description of mechanisms in place for submission of registry data to CMS electronically - Description of mechanisms to collect information (e.g.; HICN) that permits linkage of registry data with external databases (e.g.; Medicare claims data sets); - Description of data management and data quality review methods, including validation of data - The use of CMS-approved standardized data dictionary http://www.cms.gov/Medicare/Medicare-General-Information/ MedicareApprovedFacilitie/Lung-Cancer-Screening-Registries.html

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PARA Weekly Update: April 4, 2018

CMS COVERAGE UPDATE: SCREENING FOR LUNG CANCER WITH LOW DOSE CT CMS has approved the American College of Radiology (ACR) to accept data required by Medicare for LDCT Lung Cancer Screening procedures. Providers are encouraged to contact ACR now so they are able to meet the criteria for quality reporting requirements to receive reimbursement for this procedure.

The ACR link is inserted below for providers. The website contains further links to the application and attestation forms. http://www.acr.org/Quality-Safety/National-Radiology-Data-Registry/Lung-Cancer-Screening-Registry

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PARA Weekly Update: April 4, 2018

NEW CHROME VERSION OF PDE AND OTHER BROWSER FORMATS

We have been working on making the PARA Data Editor compatible with multiple web browsers so that everyone can have options when it comes to which browser to use, depending on resources or preferences.

As of today, we are making available our PARA Data Editor Multiple Web Browser (Beta) Version to everyone with a proper PARA Data Editor Login.

The Web Browsers that we are rolling out first with this version are Internet Explorer and Google Chrome.

To all users who wish to use the Multiple Web Browser (Beta) Version, please be aware that this is a PRELIMINARY version meant to work out any errors and issues that it might exhibit.

It is in the process of being updated to mirror the current production version of the PARA Data Editor.

With your help, we will be able to narrow in on fixes throughout the PARA Data Editor Multiple Web Browser (Beta) Version to then ensure full functionality and to further expand to more Web Browsers.

The PARA Data Editor Multiple Web Browser (Beta) Version can be accessed via the following link and using the appropriate login when prompted by the browser: https://www.para-hcfs.com/projects/pde_upgrade/pde_MultBrowser

Note new interface with options.

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PARA Weekly Update: April 4, 2018

NEW CHROME VERSION OF PDE AND OTHER BROWSER FORMATS

Once logged in, we would like for you to please be aware of a few key features to help us improve the PDE Multiple Browser (Beta) Version.

First, please be aware of the change in look for the Multiple Browser (Beta) Version. We are attempting to update the look and feel of the PDE to be cleaner and user-friendly.

Second, if you may have any questions, need help, would like to report an error or issue with the PDE Multiple Web Browser (Beta) Version, or anything else you may think of, click on the ?Contact Support? Link in the upper-right hand corner of the PDE:

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PARA Weekly Update: April 4, 2018

There were FIVE new or revised Med Learn (MLN Matters) article released this week.

To go to the full Med Learn document simply click on the screen shot or the link.

FIND ALL THESE MED LEARNS IN THE ADVISOR TAB OF THE PDE

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PARA Weekly Update: April 4, 2018

The link to this Med Learn: SE18001

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PARA Weekly Update: April 4, 2018

The link to this Med Learn: MM10521

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PARA Weekly Update: April 4, 2018

The link to this Med Learn: MM10567

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PARA Weekly Update: April 4, 2018

The link to this Med Learn: MM10494

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PARA Weekly Update: April 4, 2018

The link to this Med Learn: SE18003

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PARA Weekly Update: April 4, 2018

There were EIGHT new or revised Transmittals released this week.

To go to the full Transmittal document simply click

FIND ALL THESE TRANSMITTALS IN THE ADVISOR TAB OF THE PDE

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PARA Weekly Update: April 4, 2018

The link to this Transmittal R302FM

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PARA Weekly Update: April 4, 2018

The link to this Transmittal R4014CP

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PARA Weekly Update: April 4, 2018

The link to this Transmittal: R2049OTN

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PARA Weekly Update: April 4, 2018

The link to this Transmittal: R4013CP

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PARA Weekly Update: April 4, 2018

The link to this Transmittal: R4011CP

35

PARA Weekly Update: April 4, 2018

The link to this Transmittal: R782PI

36

PARA Weekly Update: April 4, 2018

The link to this Transmittal: R783PI

37

PARA Weekly Update: April 4, 2018

The link to this Transmittal: R784PI

38

PARA Weekly Update: April 4, 2018

39

PARA Weekly Update: April 4, 2018

40