CODING CORNER…FEBRUARY 2015

By Lisa Kropp, Coding and Credentialing Manager

2015 DELETED HCPCS CODES:

Below, you will find a listing of all the 2015 deleted HCPCS codes.  Please see your HCPCS books for revisions or additions.  This information will be available to you, upon request.

HCPCS Description Date Deleted
D6053 implant/abutment supported removable denture for completely edentulous arch

1/1/2015

G8552 All quality actions for the applicable measures in the ischemic vascular disease (IVD) measures group have been performed for this patient

1/1/2015

G8547 I intend to report the ischemic vascular disease (IVD) measures group

1/1/2015

G8502 All quality actions for the applicable measures in the back pain measures group have been performed for this patient

1/1/2015

G8501 All quality actions for the applicable measures in the perioperative care measures group have been performed for this patient

1/1/2015

G8492 I intend to report the perioperative care measures group

1/1/2015

G8406 Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure

1/1/2015

G8128 Clinician documented that patient was not an eligible candidate for antidepressant medication during the entire 12 week acute treatment phase measure

1/1/2015

G8126 Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase

1/1/2015

G0922 No documentation of disease type, anatomic location, and activity, reason not given

1/1/2015

G0920 Type, anatomic location, and activity all documented

1/1/2015

G0919 Influenza immunization ordered or recommended (to be given at alternate location or alternate provider); vaccine not available at time of visit

1/1/2015

G0910 Most recent hemoglobin level <= 12.0 g/dl

1/1/2015

G0909 Hemoglobin level measurement not documented, reason not given

1/1/2015

G0908 Most recent hemoglobin (HgB) level > 12.0 g/dl

1/1/2015

G0461 Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain

1/1/2015

G0457 Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area greater than 50 sq cm

1/1/2015

G0456 Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 sq cm

1/1/2015

G0419 Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, >60 specimens

1/1/2015

G0418 Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 41-60 specimens

1/1/2015

G0251 Linear accelerator based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, maximum 5 sessions per course of treatment

1/1/2015

G0173 Linear accelerator based stereotactic radiosurgery, complete course of therapy in one session

1/1/2015

C9735 Anoscopy; with directed submucosal injection(s), any substance

1/1/2015

C9135 Factor IX (antihemophilic factor, recombinant), Alprolix, per IU

1/1/2015

C9134 Factor XIII (antihemophilic factor, recombinant), Tretten, per 10 IU

1/1/2015

C9023 Injection, testosterone undecanoate, 1 mg

1/1/2015

C9022 Injection, elosulfase alfa, 1 mg

1/1/2015

C9021 Injection, obinutuzumab, 10 mg

1/1/2015

C1300 Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval

1/1/2015

A7042 Implanted pleural catheter, each

1/1/2015

J0150 Injection, adenosine for therapeutic use, 6 mg (not to be used to report any adenosine phosphate compounds, instead use A9270)

1/1/2015

G9272 LDL value >= 100

1/1/2015

G9271 LDL value < 100

1/1/2015

G9253 Adenoma(s) or other neoplasm not detected during screening colonoscopy

1/1/2015

G9252 Adenoma(s) or other neoplasm detected during screening colonoscopy

1/1/2015

G9193 Clinician documented that patient with a diagnosis of major depression was not an eligible candidate for antidepressant medication treatment or patient did not have a diagnosis of major depression

1/1/2015

G8957 Patient not receiving maintenance hemodialysis in an outpatient dialysis facility

1/1/2015

G8932 Suicide risk assessed at the initial evaluation

1/1/2015

G8931 Assessment of depression severity not documented, reason not given

1/1/2015

G8930 Assessment of depression severity at the initial evaluation

1/1/2015

G8780 Counseling for diet and physical activity performed

1/1/2015

G8779 Diabetes screening test not performed, reason not given

1/1/2015

G8464 Clinician documented that prostate cancer patient is not an eligible candidate for adjuvant hormonal therapy; low or intermediate risk of recurrence or risk of recurrence not determined

1/1/2015

G8127 Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase

1/1/2015

G9248 Patient did not have a medical visit in the last 6 months

1/1/2015

G8892 Documentation of medical reason(s) for not performing LDL-C test (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)

1/1/2015

D6975 coping

1/1/2015

D6079 implant/abutment supported fixed denture for partially edentulous arch

1/1/2015

D6078 implant/abutment supported fixed denture for completely edentulous arch

1/1/2015

D6054 implant/abutment supported removable denture for partially edentulous arch

1/1/2015

G8579 Antiplatelet medication at discharge

1/1/2015

G8552 All quality actions for the applicable measures in the ischemic vascular disease (IVD) measures group have been performed for this patient

1/1/2015

G8547 I intend to report the ischemic vascular disease (IVD) measures group

1/1/2015

G8502 All quality actions for the applicable measures in the back pain measures group have been performed for this patient

1/1/2015

G8501 All quality actions for the applicable measures in the perioperative care measures group have been performed for this patient

1/1/2015

G8492 I intend to report the perioperative care measures group

1/1/2015

G8406 Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure

1/1/2015

G8128 Clinician documented that patient was not an eligible candidate for antidepressant medication during the entire 12 week acute treatment phase measure

1/1/2015

G8126 Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase

1/1/2015

G0922 No documentation of disease type, anatomic location, and activity, reason not given

1/1/2015

G0920 Type, anatomic location, and activity all documented

1/1/2015

G0919 Influenza immunization ordered or recommended (to be given at alternate location or alternate provider); vaccine not available at time of visit

1/1/2015

G0910 Most recent hemoglobin level <= 12.0 g/dl

1/1/2015

G0909 Hemoglobin level measurement not documented, reason not given

1/1/2015

G0908 Most recent hemoglobin (HgB) level > 12.0 g/dl

1/1/2015

G0461 Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain

1/1/2015

G0457 Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area greater than 50 sq cm

1/1/2015

G0456 Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 sq cm

1/1/2015

G0419 Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, >60 specimens

1/1/2015

G0418 Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 41-60 specimens

1/1/2015

G0251 Linear accelerator based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, maximum 5 sessions per course of treatment

1/1/2015

G0173 Linear accelerator based stereotactic radiosurgery, complete course of therapy in one session

1/1/2015

C9735 Anoscopy; with directed submucosal injection(s), any substance

1/1/2015

C9135 Factor IX (antihemophilic factor, recombinant), Alprolix, per IU

1/1/2015

C9134 Factor XIII (antihemophilic factor, recombinant), Tretten, per 10 IU

1/1/2015

C9023 Injection, testosterone undecanoate, 1 mg

1/1/2015

C9022 Injection, elosulfase alfa, 1 mg

1/1/2015

C9021 Injection, obinutuzumab, 10 mg

1/1/2015

C1300 Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval

1/1/2015

A7042 Implanted pleural catheter, each

1/1/2015

J0150 Injection, adenosine for therapeutic use, 6 mg (not to be used to report any adenosine phosphate compounds, instead use A9270)

1/1/2015

G9272 LDL value >= 100

1/1/2015

G9271 LDL value < 100

1/1/2015

G9253 Adenoma(s) or other neoplasm not detected during screening colonoscopy

1/1/2015

G9252 Adenoma(s) or other neoplasm detected during screening colonoscopy

1/1/2015

G9193 Clinician documented that patient with a diagnosis of major depression was not an eligible candidate for antidepressant medication treatment or patient did not have a diagnosis of major depression

1/1/2015

G8957 Patient not receiving maintenance hemodialysis in an outpatient dialysis facility

1/1/2015

G8932 Suicide risk assessed at the initial evaluation

1/1/2015

G8931 Assessment of depression severity not documented, reason not given

1/1/2015

G8930 Assessment of depression severity at the initial evaluation

1/1/2015

G8780 Counseling for diet and physical activity performed

1/1/2015

G8779 Diabetes screening test not performed, reason not given

1/1/2015

G8464 Clinician documented that prostate cancer patient is not an eligible candidate for adjuvant hormonal therapy; low or intermediate risk of recurrence or risk of recurrence not determined

1/1/2015

G8127 Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase

1/1/2015

G9248 Patient did not have a medical visit in the last 6 months

1/1/2015

G8892 Documentation of medical reason(s) for not performing LDL-C test (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)

1/1/2015

D6975 coping

1/1/2015

D6079 implant/abutment supported fixed denture for partially edentulous arch

1/1/2015

D6078 implant/abutment supported fixed denture for completely edentulous arch

1/1/2015

D6054 implant/abutment supported removable denture for partially edentulous arch

1/1/2015

G8579 Antiplatelet medication at discharge

1/1/2015

G8552 All quality actions for the applicable measures in the ischemic vascular disease (IVD) measures group have been performed for this patient

1/1/2015

G8547 I intend to report the ischemic vascular disease (IVD) measures group

1/1/2015

G8502 All quality actions for the applicable measures in the back pain measures group have been performed for this patient

1/1/2015

G8501 All quality actions for the applicable measures in the perioperative care measures group have been performed for this patient

1/1/2015

G8492 I intend to report the perioperative care measures group

1/1/2015

G8406 Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure

1/1/2015

G8128 Clinician documented that patient was not an eligible candidate for antidepressant medication during the entire 12 week acute treatment phase measure

1/1/2015

G8126 Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase

1/1/2015

G0922 No documentation of disease type, anatomic location, and activity, reason not given

1/1/2015

G0920 Type, anatomic location, and activity all documented

1/1/2015

G0919 Influenza immunization ordered or recommended (to be given at alternate location or alternate provider); vaccine not available at time of visit

1/1/2015

G0910 Most recent hemoglobin level <= 12.0 g/dl

1/1/2015

G0909 Hemoglobin level measurement not documented, reason not given

1/1/2015

G0908 Most recent hemoglobin (HgB) level > 12.0 g/dl

1/1/2015

G0461 Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain

1/1/2015

G0457 Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area greater than 50 sq cm

1/1/2015

G0456 Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 sq cm

1/1/2015

G0419 Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, >60 specimens

1/1/2015

G0418 Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 41-60 specimens

1/1/2015

G0251 Linear accelerator based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, maximum 5 sessions per course of treatment

1/1/2015

G0173 Linear accelerator based stereotactic radiosurgery, complete course of therapy in one session

1/1/2015

C9735 Anoscopy; with directed submucosal injection(s), any substance

1/1/2015

C9135 Factor IX (antihemophilic factor, recombinant), Alprolix, per IU

1/1/2015

C9134 Factor XIII (antihemophilic factor, recombinant), Tretten, per 10 IU

1/1/2015

C9023 Injection, testosterone undecanoate, 1 mg

1/1/2015

C9022 Injection, elosulfase alfa, 1 mg

1/1/2015

C9021 Injection, obinutuzumab, 10 mg

1/1/2015

C1300 Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval

1/1/2015

A7042 Implanted pleural catheter, each

1/1/2015

J0150 Injection, adenosine for therapeutic use, 6 mg (not to be used to report any adenosine phosphate compounds, instead use A9270)

1/1/2015

G9272 LDL value >= 100

1/1/2015

G9271 LDL value < 100

1/1/2015

G9253 Adenoma(s) or other neoplasm not detected during screening colonoscopy

1/1/2015

G9252 Adenoma(s) or other neoplasm detected during screening colonoscopy

1/1/2015

G9193 Clinician documented that patient with a diagnosis of major depression was not an eligible candidate for antidepressant medication treatment or patient did not have a diagnosis of major depression

1/1/2015

G8957 Patient not receiving maintenance hemodialysis in an outpatient dialysis facility

1/1/2015

G8932 Suicide risk assessed at the initial evaluation

1/1/2015

G8931 Assessment of depression severity not documented, reason not given

1/1/2015

G8930 Assessment of depression severity at the initial evaluation

1/1/2015

G8780 Counseling for diet and physical activity performed

1/1/2015

G8779 Diabetes screening test not performed, reason not given

1/1/2015

G8464 Clinician documented that prostate cancer patient is not an eligible candidate for adjuvant hormonal therapy; low or intermediate risk of recurrence or risk of recurrence not determined

1/1/2015

G8127 Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase

1/1/2015

G9248 Patient did not have a medical visit in the last 6 months

1/1/2015

G8892 Documentation of medical reason(s) for not performing LDL-C test (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)

1/1/2015

D6975 coping

1/1/2015

D6079 implant/abutment supported fixed denture for partially edentulous arch

1/1/2015

D6078 implant/abutment supported fixed denture for completely edentulous arch

1/1/2015

D6054 implant/abutment supported removable denture for partially edentulous arch

1/1/2015

G8932 Suicide risk assessed at the initial evaluation

1/1/2015

G8931 Assessment of depression severity not documented, reason not given

1/1/2015

G8930 Assessment of depression severity at the initial evaluation

1/1/2015

G8780 Counseling for diet and physical activity performed

1/1/2015

G8779 Diabetes screening test not performed, reason not given

1/1/2015

G8464 Clinician documented that prostate cancer patient is not an eligible candidate for adjuvant hormonal therapy; low or intermediate risk of recurrence or risk of recurrence not determined

1/1/2015

G8127 Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase

1/1/2015

G9248 Patient did not have a medical visit in the last 6 months

1/1/2015

G8892 Documentation of medical reason(s) for not performing LDL-C test (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)

1/1/2015

D6975 coping

1/1/2015

D6079 implant/abutment supported fixed denture for partially edentulous arch

1/1/2015

D6078 implant/abutment supported fixed denture for completely edentulous arch

1/1/2015

D6054 implant/abutment supported removable denture for partially edentulous arch

1/1/2015

If you would like more information about how we can tailor our services to meet your needs, please contact Lisa Kropp; Coding & Credentialing Manager at 716.348.3904 or lisak@pracfirst.com

 

BILLING UPDATES – FEBRUARY 2015

By Sarah Howarth, Billing Manager

IRS INSURANCE COMPANY PAYMENT SUMMARY

PF will aggregate your IRS Form 1099’s through February 15th.  These forms (1099-Misc) represent all of the payments made to you during calendar year 2014.  The IRS matches the aggregate of all 1099’s to the appropriate line of your entity’s tax return, to make sure recipients properly report their income.  In addition, any interest paid on claims is separately reportable on IRS Form 1099-Int.  This information is also matched and it is critical to properly report this income on the correct line of your tax return to avoid IRS scrutiny for under reporting income.

By law, insurance payers should mail them by January 31st.  However, our past experience indicates that they do not comply by the due date and therefore they are not all received until the third week in February.  At that time, we will send them to you by mail or through our courier service.

FLU VACCINES

Please notify Practicefirst of any changes to the type of flu vaccine administered at your office.  We will confirm the appropriate CPT code is applied based on the brand, dosage and source of the vaccine.

Pneumoncoccal Vaccine

  • For services from 05/01/1981-09/18/2014, the Medicare part B program covered pneumococcal pneumonia vaccine and its administration only to persons at high risk of serious pneumococcal disease.
  • Effective for dates of service on or after 09/19/2014 the pneumococcal vaccine will be covered for all Medicare beneficiaries who have never received the vaccine under Medicare Part B.
    • An initial pneumococcal vaccine will be covered as well as:
    • A different, second pneumococcal vaccine one year after the first was administered.

ACIP updated guidelines recommending the administration of two different pneumococcal vaccinations.

EXCELLUS

Over the next few weeks, your office may receive a call from the Excellus automated system reminding you to make updates/changes to your office demographic information.  This information will be listed in the provider directory, please ensure accurate information is provided.

MEDICAID PRIMARY CARE RATE INCREASE (PCRI) ENDED 12/31/14

Eligible providers who have been receiving increased payments from Medicaid through the PCRI has ended. This increase was valid for dates of service from January 1, 2013 through December 31, 2014.

Medicaid systems have been updated to process claims without the rate increase for services provided on and after Januar