October 6 2017 PARA Weekly Update for Users

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PARA WEEKLY

UPDATE For Users

Improving T he Businessof HealthCare Since 1985 October 6, 2017 NEWS FOR HEALTHCARE DECISION MAKERS JANUARY 1, 2018 CMS UPDATES AN ONGOING PREVIEW OF CHANGES YOU'LL NEED TO KNOW QUESTION AND ANSWER FEATURES -

CPT Venogram

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Catheter Drainage of Soft Tissue Hematoma

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OPPS C-Codes For Echocardiography With Contrast

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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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PARA Weekly Update: October 6, 2017

CPT VENOGRAM

Question: What is the appropriate CPT ÂŽcode(s) to report a Venogram of the right lower extremity and inferior vena cava and left internal jugular vein?

Procedure: The patient was placed supine and sedated with fentanyl and Versed. The procedure was started by prepping both groins, but the right groin was entered with 1% Xylocaine plain, 18-gauge needle into the right common femoral vein and guidewire inserted.

Venogram showed the right iliac veins to be patent, although they were somewhat small, they were patent with antegrade flow and vena cava was widely patent up to the diaphragm. The physician advanced a glidewire up to the right atrium and inferior vena cavagram showed the right atrium and vena cava to be widely patent. Next the physician advanced further, and went out the azygos vein.

There was a large hemiazygos vein that goes posterior. It is the primary drainage into the right atrium from above. The physician attempted a glide-wire and a Bern catheter.

The wire curled. It appeared to be going into clot or possibly even subintimal, but would not go into the right or left innominate veins.

Subsequent pictures showed it was within the lumen, but it was occluded. Next to the right neck. Ultrasound of the right jugular vein was patent distally. It was small proximally at the clavicle, but it was patent. The right neck was scrubbed and prepped with ChloraPrep and draped in a sterile fashion.

Using ultrasound guidance, a 21-gauge needle was inserted in the right jugular vein and an 0.018 wire inserted. This went down to just below the clavicle, but would not go in the innominate vein. The physician placed the 0.018 dilator into the jugular vein, and venogram showed the jugular vein was occluded at the base of the neck. However, ultrasound showed the right subclavian vein to be patent, so I punctured the right subclavian vein under ultrasound guidance and 0.018 wire went down the innominate vein.

A 5-French sheath was inserted over the wire and superior vena cavagram showed the right innominate vein to be patent. It was small. Right subclavian appeared normal. It went down to the chest and then filled multiple collaterals, but did not go into the right atrium. However, it appeared that the innominate vein was close to the sheath placed in the right ventricle, so the physician took a glidewire and a Bern catheter and tried to cross this occlusion.

The wire sort of curled and went down. It looked close, but doing a venogram showed extravasated into the mediastinum. Oblique views were done and found that the innominate vein from above was several centimeters anterior to the azygos vein and right atrium from below. Apparently, there is a long segment occlusion of the superior 2

PARA Weekly Update: October 6, 2017

CPT VENOGRAM

vena cava, but the innominate is draining into the right atrium. It appeared to be 2-3 cm distance. The physician went to the left neck. The left jugular vein was widely patent. The left neck was prepped with ChloraPrep and punctured with a 21-gauge micropuncture needle under ultrasound guidance. Guidewire and 5-French catheter inserted. Venogram from the left side showed the left jugular and innominate vein to be patent.

They were somewhat small. It did appear to reflux over and go up the right innominate vein, although it did not fill any collaterals going to the right atrium. I reviewed these films. Several venograms were performed with AP and oblique views, although in the AP view appears they overlap the oblique view so that the innominate and the SVC are several centimeters apart, with uncertainty if in the SVC or azygos, or that the innominate veins aren't large collaterals from the azygos or other mediastinal vessels. , the physician stopped further attempts at crossing this chronic total occlusion.

Heparin was given for the procedure, but no additional anticoagulation given. The patient was observed for 2 hours and discharged home in stable condition. Final Diagnosis was Superior Vena Cava Syndrome.

Answer: Report CPT速 code 36011 (Selective Catheter Placement, venous system, first order), 36010 (Introduction of catheter, superior or inferior vena cava) and 36000 (Introduction of needle/ intra-catheter vein). The body of the report indicates venography is performed from the right femoral vein access.

The catheter is advanced to the inferior vena cava, and vena cavagram is performed.

The catheter is advanced from here to the azygos vein, which is a vein off the superior vena cava, and would be a 1st order selection.

This documentation supports CPT速 code 36011. Then, the right jugular vein is accessed, with venography performed. The catheter is advanced to the superior vena cava, and superior vena cavagram is performed, supporting CPT速 cod 36010. Finally, the left jugular is accessed and venogram is performed from this vessel, supporting CPT速 code 36000.

This catheter is not advanced to the vena cava. Regardless of the access point, once the catheter is placed in the vena cava, this becomes our starting point for vessel selection.

Both 36010 and 36000 are considered components of comprehensive code 36011 per the NCCI. However, these procedures are performed from separate access points of the right jugular and left jugular.

It would be appropriate to append -59 (XU) to both 36010 and 36000 to indicate these are separate accesses. Please refer to the PARA Data Editor CCI Edits and Code descriptions.

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PARA Weekly Update: October 6, 2017

CPT VENOGRAM

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PARA Weekly Update: October 6, 2017

CPT CATHETER DRAINAGE OF SOFT TISSUE HEMATOMA

Question: What is the appropriate CPT速 code(s) to report a catheter drainage of a soft tissue hematoma?

Procedure: A hematoma in the soft tissue of the neck is drained using a catheter. The area over the abnormal tissue is cleansed and local anesthesia is administered.

Imaging is performed to assist in the insertion of a needle/ guidewire into the fluid collection. Small tissue samples are collected from the site for pathological examination. A catheter is inserted to drain and collect the fluid for analysis. The catheter is attached to a drainage system to allow for further drainage over the course of days. Once the fluid has completely drained, the catheter is removed. A bandage is applied.

Answer: Report CPT速 code 10030, Image-guided fluid collection drainage by catheter, soft tissue. CPT速 code 10030 includes a fluid collection from an abscess, hematoma, seroma, lymphocele or cyst in the code description. The code description also includes extremity, abdominal wall and neck. The procedure note indicates the drainage catheter is left in place and secured for prolonged drainage. Please refer to the PARA Data Editor CPT速 Assistant August 2017 reference, which supports PARA?s recommendation. Please refer to the PARA Data Editor code parentheticals

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PARA Weekly Update: October 6, 2017

OPPS C-CODES FOR ECHOCARIOGRAPHY WITH CONTRAST Under Medicare?s OPPS reimbursement methodology, contrast material used in diagnostic imaging is not separately reimbursed, but ?packaged? into the imaging procedure code.

When an imaging procedure is performed with contrast sometimes, but not always, Medicare offers alternative HCPCS C-codes for facilities to report when contrast is used.

The C-Codes offer higher reimbursement to compensate the facility for the contrast expense.

The C-codes are for facility use only, the interpreting physician (cardiologist or radiologist) will report the appropriate CPTÂŽ code whether contrast was used or not, since the physician will not incur additional expense due to the use of contrast.

Professional fee reimbursement is not affected.

One of the more common imaging procedures with an alternate C-Code is 93306, transthoracic echocardiograph. Medicare reimburses 93306 under APC 5524, ?Level 4 Imaging without Contrast? at national rate of $449.68. However, if contrast is used (typically Q9957 -- INJECTION, PERFLUTREN LIPID MICROSPHERES, PER ML), HCPCS C8929 should be reported. C8929 is paid under APC 5573 ? ?Level 3 Imaging with contrast.? C8929 yields over $200 in additional reimbursement over 93306.

PARA clients may wish to review whether claims submitted to Medicare under OPPS in 2016 reported 93306 with Q9957, which would indicate that full reimbursement was not claimed. The PARA Data Editor RAC tab offers a feature for quick access to this information:

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PARA Weekly Update: October 6, 2017

OPPS C-CODES FOR ECHOCARDIOGRAPHY WITH CONTRAST

A list of the alternative C-Codes to report when contrast is used for echocardiography is provided on the following pages:

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PARA Weekly Update: October 6, 2017

OPPS C-CODES FOR ECHOCARIOGRAPHY WITH CONTRAST

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PARA Weekly Update: October 6, 2017

JANUARY 1, 2018 CMS UPDATES The following Transmittals have been published for the January 1 update.

This list will continue to expand in the coming weeks, and links to all documents can be found in the PDE Advisor tab.

Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2018

January 2018 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing

Files and Revisions to Prior Quarterly Pricing Files

Quarterly Influenza Virus Vaccine Code Update - January 2018

Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 24.0, Effective January 1, 2018

To go to the full Transmittal document simply click on the screen shot.

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PARA Weekly Update: October 6, 2017

JANUARY 1,2018 CMS UPDATESS

Instructions for Downloading the Medicare ZIP Code File for January 2018

Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) - January 2018

Affordable Care Act Bundled Payments for Care Improvement Initiative - Recurring File Updates Models 2 and 4 January 2018 Updates

Health Insurance Portability and Accountability Act (HIPAA) Electronic Data Interchange (EDI) Front End Updates for January 2018 This link leads to a ZIP file containing several files with several documents.

To go to the full Transmittal document simply click on the screen shot.

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PARA Weekly Update: October 6, 2017

There is ONE 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 Data Editor (see example below.) To go to the full Med Learn document simply click on the screen shot or the link.

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PARA Weekly Update: October 6, 2017

The link to this Med Learn: MM10306

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PARA Weekly Update: October 6, 2017

There were TEN 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 Data Editor. To go to the full Transmittal document simply click on the screen shot or the link.

The link to this Transmittal #R747PI

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PARA Weekly Update: October 6, 2017

The link to this Transmittal #R1928OTN

The link to this Transmittal #R3878CP

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PARA Weekly Update: October 6, 2017

The link to this Transmittal #R3876CP

The link to this Transmittal #R7p233

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PARA Weekly Update: October 6, 2017

The link to this Transmittal #R1930OTN

The link to this Transmittal #R1929OTN

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PARA Weekly Update: October 6, 2017

The link to this Transmittal #R1933OTN

The link to this Transmittal #R3872CP

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PARA Weekly Update: October 6, 2017

The link to this Transmittal #R3873CP

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

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PARA Weekly Update: October 6, 2017

The PDE Editor Bulletin Board Tablet lists all articles added to the Bulletin Board

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PARA Weekly Update: October 6, 2017

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