CorroHealth Weekly eJournal, August 23, 2023

j our nal e

Rotator

Cuff Tears

AcuteAnd Chronic

Ultrasound

Elastography

BillingFor This New Procedure

PHARMACY: SINGLEAND MULTI-USEVIALS

Pharmacy: Single And Multi-Use Vials

Quest ion:

If we have a produced labeled as "multi-dose vial" from the manufacturer, and we choose to utilize it as a single dose vial (used only for one patient), are we able to bill payers as if this were a single-dose vial?

Answ er:

According to the most recent CMSFAQ document regarding modifiers JW and JZ, only those drugs which are manufactured as single-use vials & are separately payable under Medicare part B would require the JW or JZ modifier.

https://apps.para-hcfs.com/pde/documents/JW%20JZ%20Modifier FAQ 7.26.2023 0.pdf

Therefore, if you provide a patient the entirety of a vial that was intended to be multi-use, there is no action you need to take regarding appending the JZ or JW modifiers The amount of the drug provided to the patient should be reported on the claim using the appropriate number of units

Supply Question In Purchasing

Quest ion:

Our purchasing department was asked to order Pressure Injectible Arrowg+ard Blue Plus® Three Lumen CVC, and the manufacturer is Teleflex

Does this item have a Ccode associated with it?Can this be charged out as a supply on the claim?

Answ er:

We recommend using HCPCScode C1751to report the CVCsupply you?ve described. Under Medicare?s Outpatient Prospective Payment System (OPPS), code C1751 is packaged and therefore does not carry separate reimbursement

https://mms.mckesson.com/ product/1048750/Teleflex-CDC-42703-XP1A

Billing For New Procedure:

Ultasound Elastography

Quest ion:

We are looking at possibly adding this procedure at our hospital. Can you provide some guidance for both coding and billing the following CPT® codes: 76981, 76982 and 76983?

Answ er:

Codes 76981, 76982, and 76983 represent ultrasound elastography (USE). Elastography is a technique for evaluating tissue elasticity (stiffness). It is used to identify malignant tumors, which are less elastic than non-malignant tumors, as well as to diagnose conditions like fibrosis and cirrhosis which cause an organ to become firmer

76981 may be assigned only once per session for evaluation of the same organ. If both an organ?s parenchyma (tissue) and lesion(s) in the same organ are evaluated during the same session, only 76981 should be assigned.

76982 is assigned for USelastography of the first target lesion within an organ, while+76983is reported for each additional target lesion evaluated within the same organ. +76983 is only reported with 76982 and should not be reported more than two times per organ

BILLINGFORNEW PROCEDURE: ULTRASOUND ELASTOGRAPHY

USEmay be performed as a stand-alone procedure or in conjunction with a diagnostic ultrasound Since USEdoes not by definition include diagnostic imaging, if a diagnostic US study of the same location is ordered, medically necessary, performed, and documented during the same session, it may be reported separately Depending on payer policy, a modifier (e.g., 59, XU) may be required. For example, Medicare has the following NCCI edits in place for diagnostic USof the abdomen and USEof organs/lesions within the abdomen:

The CPT® manual states that ALL ultrasound requires image documentation and a final, written report

The CMS 72-Hour Rule

Quest ion:

Regarding the 72 hour rule for CMS, we noticed recently a high volume of claim rejections from DDEand those are outpatient Medicare overlapping encounters,--for example and ED visit and Radiology visit within three days, and the diagnoses are not related.

Should these encounters need to be combined?

Answ er:

The 72-hour rule does not apply to Critical Access Hospitals; CAH?s report outpatient services separately from inpatient care.

We need to see the claims and the rejection or edit to evaluate the problem.

Here?s an excerpt from the Medicare Claims Processing Manual, Chapter 3 ? Inpatient Hospital Billing:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c03.pdf

Acute Versus Chronic Rotator Cuff Tear

Quest ion:

We are coding a patient who had a traumatic right rotator cuff tear, but it was many years ago. We see this as more of a chronic condition and would code it with a "M" (M75111) code.

Now, we are wondering if this would be coded with a "S" code which is the path the end coder leads you down (S46.011A or S46.011D) or a "M" code because it has become a chronic condition?Some coders code it with a "S" code but put it as sequela instead of initial and we are not sure if that would be correct either Can you offer some guidance?

Answ er:

There two major injuries for rotator cuffs tears; Traumatic and Non-traumatic.

- Traum at ic:Traumatic injuries occur when an impact or other detrimental cause damages the rotator cuff. If the tear was caused by an injury/trauma, it is considered acute regardless of how long ago the injury occurred If an injury/trauma is documented, S46 01- is reported based on indexing (tear>rotator cuff>traumatic) Traumatic codes are found in the Ssection of the ICD-10 manual, so if determined the injury is traumatic, use the following codes:

NOTE:These codes will require a seventh character to specify whether this encounter can be identified as initial, subsequent, or sequela

Non-t raum at ic:Non-traumatic, by contrast, is a tear or rupture that occurs over time by overuse and are often involved with other chronic shoulder conditions, such as arthritis.. These types of tears can be the result of years of use and are often referred to as a degenerative tear

If an injury or trauma is not documented, default indexing leads to M75.1(tear>rotator cuff). For non-traumatic codes, refer to the M section of your ICD-10-CM manual, listed here.

If the provider has included a diagnosis in the final diagnostic statement, such as the discharge summary or the face sheet, it should ordinarily be coded Some providers include in the diagnostic statement resolved conditions or diagnoses and status-post procedures from previous admission that have no bearing on the current stay. Such conditions are not to be reported and are coded only if required by hospital policy

PRICETRANSPARENCY FINES: COULD YOU BENEXT?

Price Transparency Hospital Fines Could you benext?

CMSissued fines to three hospitals in late July for price transparency violations, bringing the total number of hospitals that have been fined to seven

Here are the fine amounts CMShasleviedagainst the seven hospitals:

- Northside Hospital Atlanta: $883,180

- Community First Medical Center (Chicago): $847,740

- Northside Hospital Cherokee (Canton, Ga.): $214,320

- Kell West Regional Hospital (Wichita Falls, Texas): $117,260*

- Frisbie Memorial Hospital (Rochester, N.H.): $102,660

- Falls Community Hospital and Clinic (Marlin, Texas): $70,560

- Fulton County Hospital (Salem, Ark ): $63,900

*Kell West Medical Center is appealing the punishment; CMSis reviewing the appeal.

A complete list and details of these enforcement actions can be found here

https://www cms gov/hospital-price-transparency/enforcement-actions

For help, reach out to your CorroHealth Account Executive

CorroHealt h invit es you t o check out t he m lnconnect s page available from t he Cent ers For Medicare and Medicaid (CMS) It 's chock full of new s and inform at ion, t raining opport unit ies, event s and m ore! Each w eek PARA w ill bring you t he lat est new s and links t o available resources Click each link for t he PDF!

Thursday, August 17, 2023

New s

- CMS.gov Website Refresh ? Test Website Available for Feedback

- CMSAnnounces Resources and Flexibilities to Assist with the Public Health

Emergency in Hawaii Due to Recent Wildfires

- Clotting Factor: CY2024 Furnishing Fee

Claim s, Pricers, & Codes

- COVID-19: CPT Codes for Vaccines No Longer Authorized

- Inpatient Rehabilitation Facility Prospective Payment System: FY2024

Pricer Update

- Skilled Nursing Facility Prospective Payment System: FY2024 Pricer Update

MLN Mat t ers®Art icles

- Hospice Payments: FY2024 Update

- ICD-10 & Other Coding Revisions to National Coverage Determinations: January 2024 Update

- National Coverage Determination 30.3.3 ? Acupuncture for Chronic Low

Back Pain

- Power Seat Elevation Equipment on Power Wheelchairs

Publicat ions

- Medicare Provider Enrollment ? Revised

t r ans mit t al s

Therew ere7new or revised Transmittalsreleased thisw eek.

To go to thefull Transmittal document simply click on thescreen shot or thelink.

TRANSMITTAL R12122CPTRANSMITTAL R12191CP

TRANSMITTAL R12122CPTRANSMITTAL R12214OTN

TRANSMITTAL R12122CPTRANSMITTAL R12212OTN

TRANSMITTAL R12122CPTRANSMITTAL R12210CP

TRANSMITTAL R12122CPTRANSMITTAL R12211CP

TRANSMITTAL R12122CPTRANSMITTAL R12209PI

TRANSMITTAL R12122CPTRANSMITTAL R12213OTN

1 m edl ear ns

Therew asONEnew or revised MedLearn released thisw eek.

To go to thefull Transmittal document simply click on thescreen shot or thelink.

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