September 29 2017 PARA Weekly Update

Date

PARA WEEKLY

UPDATE For Users

Improving T he Businessof HealthCare Since 1985 September 22, 2017 NEWS FOR HEALTHCARE DECISION MAKERS 2018 CODING UPDATES EDITION GETTING READY FOR YEAR-END CPT® UPDATE -

A preview of changes expected in various clinical areas for 2018.

AREAS OF FOCUS IN THIS ISSUE -

Vascular Procedures Lab Procedures Chest & Abdomen X-Rays Behavioral Health Endoscopy Orthotics & Prostectics

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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: Page

Administration: Pages 1-40 HIM/Coding Staff: Pages 2-40 Patient Financial Services: 1-40 Providers: Pages 3,8,9,15,24,25

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Behavioral Health Pages 10, PDE Users: Pages 14,29 Mammography: Page 22 Laboratory Svcs: Pages 4,13,18,27

© PARA Healt h Car e Fin an cial Ser vices 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: September 29, 2017

2018 CODING UPDATE DOCUMENTS In preparation for the year-end CPTÂŽ update, PARA is preparing a number of short, one to two-page "coding update" documents listing deleted codes and added codes within a particular clinic area or procedure group. The coding topics addressed are those which are most likely to be "hard-coded" to a line item in a facility chargemaster. Users are advised that topics are divided into immediately related areas, and more than one paper may contain information useful to a service line manager.

Due to CPTÂŽ licensing restrictions, these documents cannot be published within the PARA Weekly Update, however PARA Data Editor (PDE) users may access the information in the Advisor tab.

Search "Coding Update" in the TYPE field, and enter 2018 in the SUBJECT field, as illustrated below.

Following the release of the OPPS Final Rule in November, coding update papers may be revised to indicate whether Medicare will accept/cover new HCPCS. PARA Data Editor Users can identify updated papers by the word "Revised" in the title and the date issued will be updated.

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PARA Weekly Update: September 29, 2017

2018 CODING UPDATE: VASCULAR PROCEDURES For 2018, the American Medical Association deleted the following codes:

There is no replacement code offered by AMA for 36120. However, in lieu of 36515, use existing code 36516 - Therapeutic apheresis; with extracorporeal selective adsorption or selective filtration and plasma reinfusion.

In addition, the following vascular procedure codes will be added in 2018:

The 2018 Medicare OPPS Proposed Rule indicates that the new codes are reimbursed under APC status indicator T, separate APC payment (except add-on code 36466, which is "packaged" status N.) 3

PARA Weekly Update: September 29, 2017

2018 CODING UPDATE: LAB PROCEDURES For 2018, the American Medical Association deleted the following codes without replacement:

The AMA added 57 new codes in 2018, primarily (but not limited to) molecular pathology, genomic sequencing, multianalyte assays, and immunology. See also PARA?s 2018 Coding Update paper on New Proprietary Lab Analysis Codes.

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PARA Weekly Update: September 29, 2017

2018 CODING UPDATE: LAB PROCEDURES Continued

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PARA Weekly Update: September 29, 2017

2018 CODING UPDATE: LAB PROCEDURES Continued

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PARA Weekly Update: September 29, 2017

2018 CODING UPDATE: LAB PROCEDURES Continued

Medicare coverage of the new codes has not yet been announced; PARA will update this paper after the CMS Clinical Lab Fee Schedule for 2018 is published, expected in November or early December, 2017.

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PARA Weekly Update: September 29, 2017

2018 CODING UPDATE: 6-MINUTE WALK TEST For 2018, the American Medical Association has deleted:

The following two new codes have been added in 2018; the AMA suggests reporting 94618 for pulmonary stress testing:

The two new HCPCS are listed as covered under the 2018 OPPS Proposed Rule as APC status indicator Q1, which packages payment for this procedure when billed with another HCPCS with APC status S, T, or V. If there are changes to the reimbursement terms in the final 2018 OPPS rule, PARA will publish an update to this paper.

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PARA Weekly Update: September 29, 2017

2018 CODING UPDATE: CHEST & ABDOMEN X-RAYS For 2018, the American Medical Association has deleted and replaced the codes used to report chest and abdomen radiological examinations. The code sets are provided below:

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PARA Weekly Update: September 29, 2017

2018 CODING UPDATE: COGNITIVE & BEHAVIORAL HEALTH For 2018, CMS has proposed to delete the following HCPCS from OPPS, according to the proposed rule.

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PARA Weekly Update: September 29, 2017

2018 CODING UPDATE:COGNITIVE & BEHAVIORAL HEALTH

The following new CPT® codes will be added by AMA in 2018:

The 2018 OPPS Medicare Proposed Rule indicates that the new CPTs will be covered under OPPS, however these codes do not appear in the 2018 Proposed Medicare Physician Fee Schedule. As more information develops regarding Medicare coverage, PARA will post an update to this paper.

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PARA Weekly Update: September 29, 2017

2018 CODING UPDATE: COGNITIVE & BEHAVIORAL HEALTH

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PARA Weekly Update: September 29, 2017

2018 CODING UPDATE:ANTICOAGULANT MANAGEMENT For 2018, the American Medical Association has deleted two anticoagulant management codes:

The following two new codes are added for 2018:

PARA does not expect the new anticoagulant management HCPCS to be covered by Medicare in 2018. Under OPPS, the old codes were not covered in 2017, and the new codes are not listed in the 2018 OPPS Proposed Rule. In addition, the 2018 Medicare Physician Fee Schedule does not include reimbursement rates for the new codes for professional fee billing.

If Medicare coverage materializes for 2018, an update to this paper will be published.

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PARA Weekly Update: September 29, 2017

CMS CLINICAL LAB FEE SCHEDULE RATES TO CHANGE IN 2018 As the final months of 2017 unfold, PARA is watching carefully for Medicare?s publication of the 2018 Clinical Laboratory Fee Schedule. In 2018, reimbursement methodology will change significantly; Medicare payment for the most commonly ordered lab tests is expected to be cut sharply.

The new clinical lab fee schedule payment rates will be based on rates paid by private payors, as reported by laboratories nationwide. The mandatory data collection period ended in May, 2017; the ClinLab ?Final Rule? was published in July, 2017, but the actual rates that will be paid per HCPCS code effective January 1, 2018 have not yet been released.

To read the Medicare publication explaining the payment methodology, click HERE. ?Payment Amounts for Services Furnished on and After January 1, 2018 Based on private payor rates from ?applicable laboratories? reported to the Centers for Medicare & Medicaid Services (CMS) by ?reporting entities,? the payment amount for a test on the new CLFS will be equal to the weighted median private payor rate for each test.

An applicable laboratory must receive greater than 50 percent of its total Medicare revenues from the CLFS and/ or the Medicare Physician Fee Schedule and at least $12,500 in revenues from only the CLFS during a 6-month data collection period.

The reporting entity with a tax identification number (TIN-level) will report private payor rate information to CMS for all of its components that are applicable laboratories. The weighted median private payor rate will be the new CLFS payment rate for most clinical laboratory services furnished on and after January 1, 2018.

When no information for a given test is reported, crosswalking or gapfilling will be used to establish a payment amount for the test. ?However, under the new CLFS, there will be no geographic adjustments to the payment amount.

For more information about the new payor rates, refer to Medicare Will Use Private Payor Prices to Set Payment Rates for Clinical Diagnostic Laboratory Tests Starting in 2018 and Medicare Clinical Diagnostic Laboratory Tests Payment System Final Rule.?

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PARA Weekly Update: September 29, 2017

2018 CODING UPDATE:NASAL ENDOSCOPY For 2018, the American Medical Association has added several nasal endoscopy codes to further differentiate procedures:

Under the 2018 OPPS Proposed Rule, these procedures are listed as reimbursed on an outpatient basis. If changes to the reimbursement status of these codes are announced in the Final Rule, PARA will publish an update to this document.

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PARA Weekly Update: September 29, 2017

2018 CODING UPDATE: HEAD, NECK, FACE SKIN FLAP PROCURES For 2018, the American Medical Association has deleted:

The following two new codes will be added in 2018:

Both the new codes are listed in the 2018 OPPS Proposed Rule as reimbursable. If there is a change to reimbursement or coverage announced in the Final Rule, PARA will post an update to this paper.

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PARA Weekly Update: September 29, 2017

2018 CODING UPDATE:HEAD, NECK, FACE SKIN FLAP PROCEDURES For 2018, the American Medical Association has deleted two anticoagulant management codes:

The following two new codes are added for 2018:

PARA does not expect the new anticoagulant management HCPCS to be covered by Medicare in 2018. Under OPPS, the old codes were not covered in 2017, and the new codes are not listed in the 2018 OPPS Proposed Rule. In addition, the 2018 Medicare Physician Fee Schedule does not include reimbursement rates for the new codes for professional fee billing.

If Medicare coverage materializes for 2018, an update to this paper will be published.

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PARA Weekly Update: September 29, 2017

2018 CODING UPDATE: NEW PROPRIETARY LAB ANALYSIS U-CODES According to the American Medical Association, Proprietary Laboratory Analyses (PLA) codes are a new addition to the CPT® code set approved by the AMA CPT® Editorial Panel. They are alpha-numeric CPT® codes with a corresponding descriptor for labs or manufacturers that want to more specifically identify their test.

The following proprietary lab analysis test codes are effective as of the date indicated.

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PARA Weekly Update: September 29, 2017

2018 CODING UPDATE:NEW PROPRIETARY LAB ANALYSIS U-CODES Continued

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PARA Weekly Update: September 29, 2017

2018 CODING UPDATE: NEW PROPRIETARY LAB ANALYSIS U-CODES

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PARA Weekly Update: September 29, 2017

2018 CODING UPDATE:NEW PROPRIETARY LAB ANALYSIS U-CODES Continued

The HCPCS 0001U through 0017U are listed as reimbursable under the 2018 OPPS Proposed Rule, although Medicare has not yet released the 2018 Clinical Lab Fee Schedule. PARA will update this paper as coverage information develops.

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PARA Weekly Update: September 29, 2017

2018 CODING UPDATE: MAMMOGRAPHY CODING UPDATE In the 2018 OPPS Proposed Rule, Medicare has proposed to delete the G0202-G0204 code set in favor of the mammography CPTsÂŽ created for 2017 by the American Medical Association. In 2017, the descriptors for the G-codes match exactly the descriptors of the corresponding CPTsÂŽ, therefore the G-codes are now duplicative.

The following table lists the proposed deletions to HCPCS:

The CPT Codes introduced in 2017 which duplicate the G020X mammography codes are:

No changes are proposed by either CMS or AMA CPT for breast tomosynthesis codes, although the descriptions for HCPCS G0279 will likely be modified to delete reference to G0202-G0204 in favor of 77065-77067.

The breast tomosynthesis code set will continue in 2018 as it has been in 2017.

This paper will be updated after CMS published the 2018 OPPS Final Rule, which is expected in the first week of November, 2018.

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PARA Weekly Update: September 29, 2017

2018 CODING UPDATE:MULTI-LAYER COMPRESSION SYSTEMS For 2018, the American Medical Association has deleted two of the four codes used to report the application of a multi-layer compression system:

The following two codes will continue in 2018:

The continued codes 29581 and 29584 are covered by Medicare in 2017, and there are no changes to coverage proposed within the 2018 under the Proposed OPPS Rule.

There has been no change to coding or Medicare coverage on the CPT for Unna Boot, 29580.

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PARA Weekly Update: September 29, 2017

2018 CODING UPDATE: ORTHOTIC/PROSTHETIC CHECK-OUT For 2018, the American Medical Association has deleted the orthotic/prosthetic "checkout" code for established patients:

97760 and 97761 will continue in 2018 with revised descriptions, and 97763 is added:

The new code 97763 is not listed within the 2018 Medicare OPPS Proposed Rule, however 97760 and 97761 will continue to be covered. This paper will be updated after the 2018 OPPS Final Rule is published in November, 2017.

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PARA Weekly Update: September 29, 2017

COPD WITH LOWER RESPIRATORY INFECTIONS Question: Effective October 1, 2016, ICD-10 guidelines instruct coders to code J44.0, COPD with lower respiratory infection when COPD is documented with another lower respiratory infectious condition, such as Acute Bronchitis. What is the appropriate ICD-10 CM code(s) to report when influenza is documented with COPD exacerbation?

Answer: Report ICD-10 CM code J44.1, COPD exacerbation, followed by J11.1, Influenza with respiratory manifestations. It would not be appropriate to report ICD-10 CM code J44.0 when influenza and COPD are both documented in the medical record. Coding Clinic 3rd Qtr 2016 states, acute bronchitis and pneumonia are both included in ICD-10 CM code J44.0 (lower respiratory infections). However, Influenza is not included in ICD-10 CM code J44.0 because it is considered both an upper and lower respiratory infection. Please refer to the PARA Data Editor ICD-10 CM code description and the Coding Clinic reference provided.

Lower Respiratory Infections Included with Chronic Obstructive Pulmonary Disease Coding Clinic, Third Quarter 2016: Page 16 Acute bronchitis and pneumonia are included, but influenza is not. Influenza involves both upper and lower respiratory infection. When present with COPD, additional codes should be assigned to specify the infection, such as bronchitis or pneumonia.

Question: ICD-10 CM Coding Guidelines instruct coders to code J44.0 when COPD is documented with a lower respiratory condition, such as pneumonia. Does this guideline apply to all types of pneumonia (i.e. Ventilator Assisted Pneumonia or Aspiration Pneumonia).

Answer: Coding Clinic 3rd Qtr 2016 identifies Pneumonia as a lower respiratory condition and instructs coders to report ICD-10 CM code J44.0, COPD with lower respiratory infection followed by the corresponding pneumonia type (J18.9) when both conditions are documented. The instructional note that precedes ICD-10 CM code J44.0, in the tabular index states "Use additional code to identify the infection". However, aspiration Pneumonia (J69.0) and ventilator associated pneumonia (J95.851) are not "respiratory infections" and therefore this guideline does not apply. Aspiration Pneumonia occurs due to inhalation of either oropharyngeal or gastric contents into the lower airways.

Ventilation Pneumonia occurs in a patient on a ventilator machine.

Please refer to the PARA Data Editor code descriptions.

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PARA Weekly Update: September 29, 2017

There were SEVEN 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: September 29, 2017

The link to this Med Learn: MM10198

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PARA Weekly Update: September 29, 2017

The link to this Med Learn: MM10317

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PARA Weekly Update: September 29, 2017

The link to this Med Learn: SE17023

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PARA Weekly Update: September 29, 2017

The link to this Med Learn: MM10240

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PARA Weekly Update: September 29, 2017

The link to this Med Learn: SE17029

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PARA Weekly Update: September 29, 2017

The link to this Med Learn: MM10234

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PARA Weekly Update: September 29, 2017

The link to this Med Learn: SE17031

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PARA Weekly Update: September 29, 2017

There were EIGHT 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.

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PARA Weekly Update: September 29, 2017

The link to this Transmittal #R3866CP

The link to this Transmittal #R1925OTN

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PARA Weekly Update: September 29, 2017

The link to this Transmittal #R3867CP

The link to this Transmittal #R11P240

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PARA Weekly Update: September 29, 2017

The link to this Transmittal #RR3871CP

The link to this Transmittal #R1927OTN

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PARA Weekly Update: September 29, 2017

The link to this Transmittal #R3870CP

The link to this Transmittal #R3869CP

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PARA Weekly Update: September 29, 2017

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

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PARA Weekly Update: September 29, 2017

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