Date
PARA WEEKLY CODING FOR HPV SCREENING
UPDATE For Users
Improving T he Businessof HealthCare Since 1985 March 28, 2018 NEWS FOR HEALTHCARE DECISION MAKERS
IN THIS ISSUE QUESTIONS & ANSWERS - Portable Pump Code G-0498 - POC Glucose Testing In Cardiac Rehab Patients - Work Capacity Evaluations - Observation Or Outpatient? - Audiology Procedures - Signatures On Laboratory Requisition Forms - Billing For Blood Products On A Hospital Claim OPPS & HCPCS UPDATE APRIL 1, 2018 CMS COVERAGE UPDATE: SCREENING FOR LUNG CANCER WITH LOW DOSE CT NEW CHROME VERSION OF PDE AND OTHER BROWSER FORMATS
PARA COMPANY NEWS ABOUT PARA SERVICES CONTACT US
4
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.
-------------------------------------------------------
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.
10
FAST LINKS: Click on the link for special areas of interest:
Page
- Administration: Pages 1-49 - HIM/Coding Staff: Pages 1-49 - Outpatient Services: Pages 2,4,36, 41,48 - Oncology: Page 2 - Providers: Pages 2-4,6,20,24
-
Cardiac Rehabilitation: Page 3 Audiology Services: Page 5 Laboratory Services: Pages 6-7 PDE Users: Pages 20,31 Finance: 34,35,39-42,44-47 DME Services: Pages 37,43
PARA Weekly Update: March 28, 2018
PORTABLE PUMP CODE G-0498
Question: We have a patient that we will start the chemo in our outpatient department and send them home with a portable pump. The pump will be provided by a medical supplier and billed to the hospital. This is the first we have done this to just want to verify the codes we are to use. G0498 and the drug? Answer: The code G0498 -- Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/ clinic setting using office/ clinic pump/ supplies, with continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted living) using a portable pump provided by the office/ clinic, includes follow up office/ clinic visit at the conclusion of the infusion) -- is correct for the service described. The pump supplier is not be permitted to bill Medicare separately; the hospital is expected to pay for the pump, as you have described. Attached is our paper on G0498 ? Medicare created this G-code to ensure that hospitals understand that the cost of the portable pump is not separately reportable by the DME provider.
https://apps.para-hcfs.com/para/ Documents/New_Prolonged_ Chemo_Infusion_ HCPCS_G0498_edited.pdf
2
PARA Weekly Update: March 28, 2018
POC GLUCOSE TESTING IN CARDIAC REHAB PATIENTS
Question: Can we charge Point Of Care (POC) glucose testing on diabetic cardiac rehab patients? About a year or so ago we quit charging for our glucometers based on DRGs and recommendations to incorporate the charge in the ?cost? of the bed. Would this logic hold for Cardiac Rehab or would this patient population fall under fee for service? Any advice or information you can provide is appreciated. Answer: POC glucose testing is billable only if ordered by a physician to immediately determine the correct course of treatment. In the cardiac rehab setting, POC glucose testing is a function of routine nursing care, and should not be billed in addition to the cardiac rehab services. Attached is our paper on POC glucose testing.
https://apps.para-hcfs. com/pde/documents/ PARA_Charging_for_POC _Blood_Glucose_ Testing.pdf
3
PARA Weekly Update: March 28, 2018
WORK CAPACITY EVALUATIONS
Question: We have a non-profit organization in our community that looks to get community dwellers most often with mental handicaps to live full lives. Part of this process, is to try and find gainful employment for this group. They have reached out to GVH to see if we can provide a basic work capacity evaluation to give them and the individual an idea as to what they are capable of doing physically. These folks are typically under Medicare or Medicaid and likely would have a ?diagnosis? such as mental retardation. We are wondering if we can legitimately bill for this service. Answer: A number of hospitals enter into contracts for industrial medicine; under the terms of the contract, the hospital performs services for eligible personnel (typically employees of a local company) to perform services which may or may not be medically necessary or covered by ordinary health insurance, such as monitoring the employee?s health due to exposure to harmful chemicals, wellness evaluations, blood tests, etc. The hospital bills the employer directly for the service. It is acceptable to bill a work capacity evaluation under the terms of a private contract with the non-profit. In fact, the evaluation need not follow CPTÂŽ or HCPCS coding guidelines, so long as both parties to the contract are clear on the scope of work and the terms of reimbursement.
OBSERVATION OR OUTPATIENT?
Question: A patient is admitted Observation as the doctor is doing testing and monitoring patient. It is found that the patient needs surgery such as an appendectomy or cholecystectomy. Surgery is performed, when the patient returns to the floor to recover, does the status remain observation (carving out surgery time) or would they need to return outpatient surgery status? If they need to be OPS, would the doctor write observation discharge orders prior to patient going to surgery and also dictate the discharge summary then? Would the surgeon have to write surgical discharge orders? Answer: Patient status should be driven by the physician order. In this case, UR could have prompted the attending to change the status from observation to outpatient surgery, or inpatient if appropriate, once the decision for surgery was made. The hospital may not bill for hours in observation status that includes time spent in other closely monitored treatment, such as surgery, recovery room, and diagnostic imaging procedures. Therefore, if the surgery resolved the problem, observation should have stopped at the time the patient entered the surgical suite, or even at the point that the decision for surgery was made. In the circumstances you described, PARA does not recommend billing for observation hours past the point in time when the attending made the decision for surgery.
4
PARA Weekly Update: March 28, 2018
AUDIOLOGY PROCEDURES
Question: Can you tell me if this sounds appropriate for our Audiology department to do? Visit 1: Comprehensive eval (pt may decide that they want a hearing aid at this visit)-only charges the eval Visit 2: (Short consultation visit): discuss hearing aid options-no charge at this visit (Our audiologist tells me that you can go to Belltone, etc. and get a free consult as well.) Visit 3: Issue hearing aid and do fitting-charge for hearing aid and fitting fee (2nd visit consult rolls into this charge) Patients sign a purchase agreement that they can trial the HA for 30 days (the fitting fee helps to cover the time and expense of audiologist during that 30 days if the patient comes in for adjustments). If the patient decides to not keep the HA at 30 days, then the HA is refunded but not the fitting fee. Patients have a two year warranty within the cost of their HA so they come back every 2 months to have the HA checked and cleaned at no additional cost. We charge after two years only if we have to send the HA in for a repair. Another scenario: if she does the eval and the patient decides they only want 1 HA, not both at that time but then within six months later the patient decides they do want the other one, she does not charge for another fitting fee since she does not have to complete the testing again and since the patient received all the instruction for the first HA. She said it takes about one hr to fit the 2nd one. If it?s greater than six months, she does charge it. The audiologist recalls something about not being able to charge an eval and a fit fee on the same visit. Is that still the case? Answer: Since Medicare does not cover hearing aids, there is not much within Medicare regulations regarding what can or should be charged for hearing aids, or billing practices for related services such as visits for fitting and dispensing a hearing aid. The practices you described in Visit 1 through 3 are not unusual; the controlling factor is typically competition in the marketplace, since hearing aids are often not covered by health insurance ? these are usually out-of-pocket expenses that patients pay. Within the description of services you?ve provided, the service that would be subject to Medicare billing requirements is the hearing evaluation 92557 is a covered code for both the facility and the professional fee. There is no CCI edit which restricts billing the fitting code (V5011?) with 92557, but that may be simply because the V-code is non-covered and therefore not reported to Medicare on claims. In general, it is not appropriate to bill a fitting fee with an evaluation, but it is acceptable if the evaluation is significant and separate from the fitting fee. 5
PARA Weekly Update: March 28, 2018
Question: Sublette is using our hospital as a reference lab. They are sending the requisition over with the specimen. We am aware that a signature is no longer needed on requisitions, but our hospital is billing Medicare/ patient for the test. We were questioning if we can even accept the requisition since we are the ones billing. We found this CMS guideline that states ?If you bill laboratory services to Medicare, you must obtain the treating physician?s signed order? ? Answer: PARA's paper outlining Medicare?s various remarks about signature requirements for outpatient lab orders is attached. The most conservative and safest approach to use is to require a physician signature on the requisition form to authenticate the order; that way, if there is an audit, the order is readily verified. If there is no signature on the requisition form, and the hospital is audited to support the order for the test, the hospital could support the claim with copies of signed office records from the ordering physician indicating his/ her intention to order the tests, and/ or the review of the results when received. However, in the event of an audit, there is usually a short time frame to submit all required documentation, and therefore the inconvenience of having to rapidly obtain a record from outside the hospital?s control can be problematic.
6
PARA Weekly Update: March 28, 2018
BILLING FOR BLOOD PRODUCTS ON A HOSPITAL CLAIM
Question: We are getting claim edits on our inpatient Medicare claims when the claims are reporting blood products and blood administration charges. Answer: Medicare and some private insurers reimburse for hospital care under a designed payment methodology called diagnosis-related groups (DRGs). DRGs are assigned based on a patient?s primary and secondary diagnosis and procedures that were performed in the course of the patient?s inpatient stay. Hospitals generally receive pre-determined payment for each DRG, regardless of the actual services rendered. Blood and blood products on an inpatient claim are rolled into this DRG payment methodology. Identifying the Type of Blood Service Using Revenue Codes in the Hospital Inpatient Setting: Revenue codes for the blood and blood products transfused will vary depending on whether the hospital incurs a blood cost or a blood processing cost. The blood center does not charge for the blood itself, but for the processing only. Hospitals are instructed by the National Uniform Bill Committee to use revenue codes as listed in the following table and illustrated on the claim example:
7
PARA Weekly Update: March 28, 2018
BILLING FOR BLOOD PRODUCTS ON HOSPITAL CLAIMS
When providers obtain blood or blood products from blood banks that charge for the blood product itself, or they run their own blood bank and assess a charge for blood or blood products, hospitals are instructed by the National Uniform Bill Committee to use revenue codes listed in the following table and illustrated on the claim example:
8
PARA Weekly Update: March 28, 2018
BILLING FOR BLOOD PRODUCTS ON HOSPITAL CLAIMS
Revenue Codes Commonly Encountered on Claims for Transfusion Medicine Services: Most blood is supplied by blood centers that do not charge for the blood itself, which is the reason why most hospitals will commonly bill for blood and blood products under revenue code 039X. Transfusion services in hospitals are always billed under revenue code 0391. In addition to blood and blood products, hospitals incur costs relative to the performance of pre-transfusion tests, blood matching and/ or other laboratory diagnostic services and laboratory pathological procedures. When reporting these services, hospitals are instructed to report these laboratory tests under revenue code 03XX. The revenue code tables below are some of the more common tests that are reported on claims with blood, blood products and transfusion services:
Reimbursement for Blood Products and Services: Hospital Outpatient (OPPS) Setting: As of August 2000, CMS now reimburses hospitals under the hospital Outpatient Prospective Payment System (OPPS), more commonly referred to as the ambulatory payment classification system (APCs). Under the APC system, reimbursement is determined by the services provided during an outpatient visit. Cases are assigned to APC groups based on the Current Procedural Terminology (CPTÂŽ ) coding system and the Healthcare Common Procedure Coding System (HCPCS) codes that are reported on a facility UB-04 claim form. Transfused blood and blood products are reimbursed separately under their own assigned APCs. Unlike DRGs, transfused blood and blood products are not ?rolled into? the APC payment rate associated with the procedure provided. To enable hospitals to receive the APC payment, a hospital must bill using the correct HCPCS code that is designated for the services rendered at the time of the visit and the blood products that were transfused. The services must also meet the criteria guidelines for medical necessity. 9
PARA Weekly Update: March 28, 2018
BILLING FOR BLOOD PRODUCTS ON HOSPITAL CLAIMS
Under Medicare Part B, the collection, processing, and storage of blood for later transfusion is not recognized as a separate procedure and no blood supplier can receive direct payment under Medicare Part B for donation services. If a blood transfusion CPTÂŽ code is reported on a claim (UB-04), then the blood or blood product must also be billed using a HCPCS code that best describes the blood or blood procedure with the appropriate revenue code assignment. Medicare will return all claims that are not correctly coded. When multiple units of blood are infused on the same day, transfusion service codes 36430, 36440, 36450, 36455 all have an assigned MUE of 1. In CMS language this translates the service code can only be reported once per services basis, regardless of how many units are infused. This same guideline applies to OPPS facilities as well as Critical Access Hospitals (CAHs) https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c04.pdf
The CPTÂŽ codes that are used for blood transfusion services are:
10
PARA Weekly Update: March 28, 2018
BILLING FOR BLOOD PRODUCTS ON HOSPITAL CLAIMS
The most common Blood-Related Procedures are displayed on the following pages. Blood-Related Procedure Codes
11
PARA Weekly Update: March 28, 2018
BILLING FOR BLOOD PRODUCTS ON HOSPITAL CLAIMS
Blood-Related Procedure Codes (continued):
12
PARA Weekly Update: March 28, 2018
BILLING FOR BLOOD PRODUCTS ON HOSPITAL CLAIMS
Blood-Related Procedure Codes (continued):
13
PARA Weekly Update: March 28, 2018
BILLING FOR BLOOD PRODUCTS ON HOSPITAL CLAIMS
The HCPCS codes that are available for billing blood and blood products are:
14
PARA Weekly Update: March 28, 2018
BILLING FOR BLOOD PRODUCTS ON HOSPITAL CLAIMS
HCPCS codes for blood and blood products (continued):
Value Codes: Value codes 37, 38 and 39 are reported on a claim only when a hospital is charged for the blood (not blood processing). The value codes are used as indicators for the number of units furnished (37), the number of units replaced (39) and the number of units applied to the blood deductible (38). Value codes do not apply when blood is only charged a processing fee. Value codes used for outpatient billing are the same as for inpatient billing. 15
PARA Weekly Update: March 28, 2018
BILLING FOR BLOOD PRODUCTS ON HOSPITAL CLAIMS
Unused Blood: Medicare does not reimburse for unused blood and the Medicare beneficiary cannot be billed for it. Providers are expected to report unused blood costs in their annual Cost Report filing. A provider may bill for medically necessary laboratory testing related to blood typing and cross-matching under revenue codes 30X or 31X that may have been associated with the unused units. 16
PARA Weekly Update: March 28, 2018
BILLING FOR BLOOD PRODUCTS ON HOSPITAL CLAIMS
Autologous Blood Used In Surgery: Many hospitals are confused as to how to bill for autologous blood and the associated services of a stand-by blood transfusion technician in the surgical suite during surgery. Not all patients who prepare for surgery donate autologous blood, and not all those who donate require a transfusion during surgery. ?Autologous? blood is a patient?s own blood. To reduce the risk of transmission of infectious diseases, autologous blood may be collected, processed and stored for use during or after a surgery in which the likelihood of transfusion is high, such as hip replacement surgery or cardiovascular surgery. Autologous blood requires special handling and separate processing and storage-consequently, autologous blood costs more than donated allogeneic blood. In addition, one-third to one-half of collected autologous blood is not needed. Unused autologous blood is stored for a period of time after the operation, typically until the patient has been discharged or the blood has reached its expiration date. Billing for autologous blood and the associated services are addressed below: - Technician Services: The expense of a standby technician in the surgical suite should be incorporated into the ?Level? charges for the operating room, and should not appear as a separately billed line item. For example, the Operating Room level may be increased from a Level II to a Level III charge for those patients who require this special standby service. - Billing for Autologous Blood Administration: When an autologous transfusion is performed, hospitals may charge for this service under Revenue Code 0391 ?Administration, Processing and Storage for Blood and Blood Components? Administration (e.g., transfusions)?. Outpatient claims should indicate HCPCS code 36430 under Revenue Code 0391 (see table below). - Billing For Autologous Blood Collected But Not Transfused: In the event that the patient does not receive some or all of the blood collected by the hospital in a billable transfusion, the hospital may bill the expense of collecting the unused autologous blood using HCPCS codes billed under revenue code 0300 ?(Laboratory? General) or 0309 (Laboratory? Other Laboratory)?. Descriptions for the pertinent HCPCS codes appear in the table below:
17
PARA Weekly Update: March 28, 2018
BILLING FOR BLOOD PRODUCTS ON HOSPITAL CLAIMS
The PARA Data Editor provides further information on the reimbursement terms related to these codes. By entering the HCPCS into the Calculator tab of the PARA Data Editor as shown below, code description and detailed reimbursement information is obtained for both the Medicare Physician Fee Schedule (for professional billing) and OPPS for APC reimbursement for outpatient services rendered by hospitals:
Results:
18
PARA Weekly Update: March 28, 2018
BILLING FOR BLOOD PRODUCTS ON HOSPITAL CLAIMS
Excerpt from the Medicare Claims Processing Manual, Chapter 4: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c04.pdf
Reference for this document: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html Chapter 4 ? Hospital Part B Section 231.1
19
PARA Weekly Update: March 28, 2018
OPPS & HCPCS UPDATE APRIL 1 2018
Medicare has released the HCPCS update effective for dates of service on or after April 1, 2018. The changes pertain to reporting biosimilar infliximab. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/MM10454.pdf Effective for services as of April 1, 2018, The April 2018 HCPCS file includes these revised/new HCPCS codes: HCPCS Code: Q5101 - Short Description: Injection, zarxio - Long Description: Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram HCPCS Code: Q5103 - Short Description: Injection, inflectra - Long Description: Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg - Type of Service (TOS) Code: 1,P - Medicare Physician Fee Schedule Database (MPFSDB) Status Indicator: E HCPCS Code: Q5104 - Short Description: Injection, renflexis - Long Description: Injection, infliximab-abda, biosimilar, (renflexis), 10 mg - TOS Code: 1, P - MPFSDB Status Indicator: E HCPCS Code: Q2041 - Short Description: Axicabtagene ciloleucel car+ - Long Description: Axicabtagene Ciloleucel, up to 200 million autologous Anti-CD19 CAR T Cells, Including leukapheresis and dose preparation procedures, per infusion - TOS Code: 1 - MPFSDB Status Indicator: E Effective for claims with dates of service on or after April 1, 2018, HCPCS code Q5102 (which describes both currently available versions of infliximab biosimilars) will be replaced with two codes, Q5103 and Q5104. Thus, Q5102 Injection, infliximab, biosimilar, 10 mg, will be discontinued, effective March 31, 2018. Also, beginning on April 1, 2018, modifiers that describe the manufacturer of a biosimilar product (for example, ZA, ZB and ZC) will no longer be required on Medicare claims for HCPCS codes for biosimilars. However, please note that HCPCS code Q5102 and the requirement to use biosimilar modifiers remain in effect for dates of service prior to April 1, 2018.
20
PARA Weekly Update: March 28, 2018
OPPS & HCPCS UPDATE APRIL 1 2018
In other news, the OPPS Update for April 1 2018 was also published in the following MedLearn: https://www.cms.gov/Outreach-and-Education/ Medicare-Learning-Network-MLN/MLNMattersArticles/ downloads/MM10515.pdf
The update informs of the following changes: One New Separately Payable Procedure Code was added.
One skin substitute product was reassigned from the Low Cost Group to the High Cost Group.
Laboratory HCPCS: Effective January 1, 2018, Medicare has acknowledged one new Multianalyte Assays with Algorithmic Analyses (MAAA) code (0011M), eleven new PLA CPT® codes(specifically, CPT® codes 0024U through 0034U) and deleted two PLA codes (CPT® codes 0004U and 0015U). These updates were made too late in the year to be published in the January 1, 2018 OPPS Update.
21
PARA Weekly Update: March 28, 2018
OPPS & HCPCS UPDATE APRIL 1 2018
22
PARA Weekly Update: March 28, 2018
OPPS & HCPCS UPDATE APRIL 1 2018
23
PARA Weekly Update: March 28, 2018
CMS COVERAGE UPDATE: SCREENING FOR LUNG CANCER WITH LOW DOSE CT Effective January 04, 2016, CMS implemented Medicare coverage of Screening for Lung Cancer with Low Dose Computed Tomography (LDCT). The coverage was added to ?Preventive Services? through the NCD process https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2015-Transmittals-Items /R185NCD.html?DLPage=1&DLEntries=10&DLFilter=MM9246&DLSort=1&DLSortDir=ascending
Further, CMS has approved the American College of Radiology as a registry. Please see elsewhere in this article for updates related to the registry process. https://www.cms.gov/Newsroom/ MediaReleaseDatabase/Pressreleases/2015-Press-releasesitems/2015-02-05.html
24
PARA Weekly Update: March 28, 2018
CMS COVERAGE UPDATE: SCREENING FOR LUNG CANCER WITH LOW DOSE CT Coding Claims For LDCT Services: Effective for claims beginning with dates of service February 05, 2016, the following HCPCS G0296 and G0297 have been established by CMS for providers to report LDCT services:
Medicare coinsurance and Part B deductibles are waived for this preventive service Claims for LDCT services must be also be billed with the following ICD-10 diagnosis code:
Institutional Billing Requirements: Following implementation of the policy, effective February 05, 2016, providers are required to use the following bill types when reporting LDCT services: 1. G0296 and G0297: 12X, 13X,22X,23X,71X 2. G0296 only: 77X and 85X Medicare will pay for these services as follows: 1. Outpatient hospital departments (OPPS) ? bill types 12X and 13X 2. Skilled nursing facilities (SNFs) ? bill types 22X and 23X (reimbursement based on Medicare Physician Fee Schedule (MPFS) 3. Critical Access Hospitals (CAHs) ? bill types 85X ? reimbursement based on reasonable cost 25
PARA Weekly Update: March 28, 2018
CMS COVERAGE UPDATE: SCREENING FOR LUNG CANCER WITH LOW DOSE CT 4. CAH Method II ? bill types 85X with revenue codes 096X,097X or 098X, reimbursement will be based on the lesser of the actual charge or the MPFS (115% of the lesser of the fee schedule amount and submitted charge) for HCPCS G0296 only 5. Rural Health Clinics (RHCs) ? TOB 71X ? reimbursement is based on the all-inclusive rate for HCPCS G0296 only 6. Federally Qualified Health Centers (FQHCs) ? TOB 77X ? reimbursement is based on the PPS rate for HCPCS G0296 only For all LDCT procedures, criteria must be met fully to enable providers to obtain CMS reimbursement. CMS criteria for beneficiary eligibility All criteria points outlined below by CMS must be met for this service to be reimbursed by Medicare coverage policies as a preventive service benefit ? - Beneficiary must be between the ages of 55 ? 77 years and - Must be asymptomatic (no signs or symptoms of lung cancer) and - Abuse of tobacco smoking history of at least 30 pack-years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes) and - Beneficiary must be a current smoker or one that has quit within the last 15 years and - Beneficiary presents with a written order specifically for LDCT that meets the following requirements - Initial LDCT lung cancer screening service: the beneficiary must receive the written order for the LDCT during a lung cancer screening counseling and shared decision-making visit and - The visit must be furnished by a physician or qualified non-physician practitioner (NPP = physician assistant, nurse practitioner or clinical nurse specialist) and - The lung cancer screening counseling and shared decision-making visit must include the following elements and must be documented in the patient?s medical records and - Determination of beneficiary eligibility that includes mention of previous eligibility requirements (patient age, asymptomatic, calculation of cigarette smoking pack-years and if a current or former smoker the number of years since quitting and - In the shared decision making, the process should include the use of one or more decision aids, include benefits and harms of screening, follow-up diagnostic testing, over-diagnosis, false positive rate and total radiation exposure and
26
PARA Weekly Update: March 28, 2018
CMS COVERAGE UPDATE: SCREENING FOR LUNG CANCER WITH LOW DOSE CT - The counseling includes the importance of continuing with annual lung cancer LDCT screening, how comorbidities impact and the ability or willingness of the beneficiary to undergo diagnosis and treatment and - A portion of the counseling should also include the importance of maintaining cigarette smoking abstinence if beneficiary is a former smoker, or the importance of smoking cessation if the beneficiary is a current smoker and - Furnishing information about tobacco cessation interventions and - The furnishing of a written order for lung cancer screening with LDCT - Subsequent LDCT lung cancer screening service: the beneficiary must receive the written order for the LDCT during a lung cancer screening counseling and shared decision-making visit. If a physician or NPP elects to provide subsequent lung cancer screening counseling and shared decision-making visit, the visit must meet all criteria as described above for the Initial visit - Written orders are required for both Initial and Subsequent LDCT lung cancer screenings and must be documented in the beneficiary?s medical records. This documentation is -
Beneficiary date of birth Actual pack-year smoking history (number) Current smoking status and or if former smoking, number of years since quitting Statement that the beneficiary is asymptomatic National Provider Identifier (NPI) of the ordering practitioner
Eligibility criteria for reading radiologist A radiologist that performs the reading and interpretation report for a lung cancer screening LDCT must have the following skill set to meet eligibility requirements - Hold a valid Board certification or board eligibility with the American Board of Radiology or any equivalent organization and - Have a documented training record in diagnostic radiology and radiation safety and - Be involved or have involvement in the supervision and interpretation of at least 300 chest computed tomography acquisitions in the past 3 years and - Documented participation in continuing medical education according to current American College Radiology standards and - Furnish lung cancer screening with LDCT in a radiology imaging facility that meets CMS eligibility criteria (listed in the next section of this document) 27
PARA Weekly Update: March 28, 2018
CMS COVERAGE UPDATE: SCREENING FOR LUNG CANCER WITH LOW DOSE CT Eligibility Criteria For A Radiology Imaging Facility That Performs LDCT Lung Cancer Screenings - Must be able to perform LDCT with volumetric CT dose index (CTDIvol) of <3.0 mGy (milligray) for standard size patients (this is to be defined as those 5?7? in height and weight approximately 155lbs) with appropriate reductions in CTDIvol for small patient and appropriate increases in CTDIvol for larger patients and - Able to utilize a standardized lung nodule identification, classification and reporting system and - Has available smoking cessation interventions for current smokers and - Collects and submits data to a CMS-approved registry for each LDCT Lung Cancer screening performed. The data collected and submitted to a CMS-approved registry must include the following elements, at the minimum.
28
PARA Weekly Update: March 28, 2018
CMS COVERAGE UPDATE: SCREENING FOR LUNG CANCER WITH LOW DOSE CT All CMS-approved registries must be able to have the capacity and capability to collect data from any Medicare-eligible imaging facility/ department that performs lung cancer screening with LDCT, with a catchment area that includes all 50 states, United State Territories and District of Columbia. CMS will evaluate each entity that is interested in becoming a CMS-approved registry for their capability in meeting the registry and data collection requirements that are outlined below in this national coverage determination (NCD). - Have established a steering committee and a govemance board for oversight of registry - Have a complete registry management plan that includes identification of key personnel - Have an operational plan and work frame that describes the mechanisms in place for collection and submission of data between the imaging facilities and the registry - Registry catchment area - Description of mechanisms in place for submission of registry data to CMS electronically - Description of mechanisms to collect information (e.g.; HICN) that permits linkage of registry data with external databases (e.g.; Medicare claims data sets); - Description of data management and data quality review methods, including validation of data - The use of CMS-approved standardized data dictionary http://www.cms.gov/Medicare/Medicare-General-Information/ MedicareApprovedFacilitie/Lung-Cancer-Screening-Registries.html
29
PARA Weekly Update: March 28, 2018
CMS COVERAGE UPDATE: SCREENING FOR LUNG CANCER WITH LOW DOSE CT CMS has approved the American College of Radiology (ACR) to accept data required by Medicare for LDCT Lung Cancer Screening procedures. Providers are encouraged to contact ACR now so they are able to meet the criteria for quality reporting requirements to receive reimbursement for this procedure. The ACR link is inserted below for providers. The website contains further links to the application and attestation forms. http://www.acr.org/Quality-Safety/National-Radiology-Data-Registry/Lung-Cancer-Screening-Registry
30
PARA Weekly Update: March 28, 2018
NEW CHROME VERSION OF PDE AND OTHER BROWSER FORMATS
We have been working on making the PARA Data Editor compatible with multiple web browsers so that everyone can have options when it comes to which browser to use, depending on resources or preferences. As of today, we are making available our PARA Data Editor Multiple Web Browser (Beta) Version to everyone with a proper PARA Data Editor Login. The Web Browsers that we are rolling out first with this version are Internet Explorer and Google Chrome. To all users who wish to use the Multiple Web Browser (Beta) Version, please be aware that this is a PRELIMINARY version meant to work out any errors and issues that it might exhibit. It is in the process of being updated to mirror the current production version of the PARA Data Editor. With your help, we will be able to narrow in on fixes throughout the PARA Data Editor Multiple Web Browser (Beta) Version to then ensure full functionality and to further expand to more Web Browsers. The PARA Data Editor Multiple Web Browser (Beta) Version can be accessed via the following link and using the appropriate login when prompted by the browser: https://www.para-hcfs.com/projects/pde_upgrade/pde_MultBrowser
Note new interface with options. 31
PARA Weekly Update: March 28, 2018
NEW CHROME VERSION OF PDE AND OTHER BROWSER FORMATS
Once logged in, we would like for you to please be aware of a few key features to help us improve the PDE Multiple Browser (Beta) Version. First, please be aware of the change in look for the Multiple Browser (Beta) Version. We are attempting to update the look and feel of the PDE to be cleaner and user-friendly. Second, if you may have any questions, need help, would like to report an error or issue with the PDE Multiple Web Browser (Beta) Version, or anything else you may think of, click on the ?Contact Support? Link in the upper-right hand corner of the PDE:
32
PARA Weekly Update: March 28, 2018
There were FOUR new or revised Med Learn (MLN Matters) article released this week. To go to the full Med Learn document simply click on the screen shot or the link.
FIND ALL THESE MED LEARNS IN THE ADVISOR TAB OF THE PDE
33
PARA Weekly Update: March 28, 2018
The link to this Med Learn: MM10531
34
PARA Weekly Update: March 28, 2018
The link to this Med Learn: MM10515
35
PARA Weekly Update: March 28, 2018
The link to this Med Learn: MM10514
36
PARA Weekly Update: March 28, 2018
The link to this Med Learn: MM10503
37
PARA Weekly Update: March 28, 2018
There were TEN new or revised Transmittals released this week. To go to the full Transmittal document simply click
FIND ALL THESE TRANSMITTALS IN THE ADVISOR TAB OF THE PDE
38
PARA Weekly Update: March 28, 2018
The link to this Transmittal R301FM
39
PARA Weekly Update: March 28, 2018
The link to this Transmittal R2047OTN
40
PARA Weekly Update: March 28, 2018
The link to this Transmittal: R4005CP
41
PARA Weekly Update: March 28, 2018
The link to this Transmittal: R4006CP
42
PARA Weekly Update: March 28, 2018
The link to this Transmittal: R4004CP
43
PARA Weekly Update: March 28, 2018
The link to this Transmittal: R4007CP
44
PARA Weekly Update: March 28, 2018
The link to this Transmittal: R2048OTN
45
PARA Weekly Update: March 28, 2018
The link to this Transmittal: R4008CP
46
PARA Weekly Update: March 28, 2018
The link to this Transmittal: R4009CP
47
PARA Weekly Update: March 28, 2018
The link to this Transmittal: R4010CP
48
PARA Weekly Update: March 28, 2018
49