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Effective July 1st certain new codes and billing instructions are updated

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The Outpatient Prospective Payment System (OPPS) includes significant changes billing instructions for various payment policies as indicated in the 2016 OPPS final rule.

Find below mentioned the effective Changes:

Instructions are being revised to clarify that payment for services identified by RADIOLOGY CPT CODES 77014, 77280, 77285, 77290, 77295, 77306-77321, 77331, and 77370 are included in the AMBULATORY PAYMENT CLASSIFICATION (APC) payment for CPT code 77301 Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications.

This July update also revised a handful of status indicators for Pathology CPT codes.  Effective from July 1, 2016 the SI for 85396 Coagulation/fibrinolysis assay, whole blood (e.g., viscoelastic clot assessment), including use of any pharmacologic additive(s), as indicated, including interpretation and written report per day and 88141 Cytopathology, cervical or vaginal (any reporting system) requiring interpretation by physician will change from Q4 Conditionally packaged laboratory tests to N no additional payment, payment included in line items with APCs for incidental service; and the SI for 88174 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision and 88175 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescrubbing or review  under physician supervision will change from N to Q4.

CMS is revising its policy to clarify providers should not separately report non-therapy outpatient department services that are adjunctive or similar to a comprehensive APC (C-APC) procedure (SI J1), or the specific combination of services assigned to the Observation Comprehensive APC 8011 (SI J2), with therapy CPT codes specifically, outpatient physical therapy, outpatient speech-language pathology, and outpatient occupation therapy furnished either by therapists or non-therapists, and included on the same claim as the C-APC procedure.

New Category III codes made effective from July 1st Category III code 0438T Transperineal placement of biodegradable material, peri-prostatic (via needle), single or multiple, includes image guidance will replace HCPCS Level II code C9743 Injection/implantation of bulking or spacer material (any type) with or without image guidance (not to be used if a more specific code applies).

The update also implements HCPCS Level II code Q9981 Rolapitant, oral, 1 mg, SI K, APC 1761with effective from 1st HCPCS Level II code Q4164 Helical, per sq cm is being reassigned from the low-cost skin substitute group to the high-cost skin group.  HCPCS Level II code Q9982 Flutemetamol F18, diagnostic, per study dose, up to 5 millicuries will replace C9459, and Q9983 Florbetaben F18, diagnostic, per study dose, up to 8.1 millicuries will replace C9458.

HCPCS Level II codes C1713 Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) and C1817 Septal defect implant system, intracardiac will be added to the list of devices allowed for the device intensive procedure from 1st July, 2016.