In This Issue... Medicare Guidelines on Telehealth Services Benefit Expansion, Coverage and Conditions for Reimbursement of These Services ............... 5 Medicare eNews Now Available Join Florida Medicare eNews Mailing List to Receive Important News and Information ........ 9 Expansion of Coverage on Percutaneous Transluminal Angioplasty Coverage Expansion and Claim Processing Instructions for Hospital Inpatient Services ..... 12 Skilled Nursing Facility Consolidated Billing Clarification to Health Insurance Prospective Payment System Coding and Billing Guidelines .............................................................................................................................. 15 Final Medical Review Policies 10060, 55873, 67221, 71250, 74150, 84155, 85007, 88141, 92225, 93303, A0430, G0030,G0104, G0108, J1561, J1745, J9212, and M0302 ...................................... 22 Outpatient Prospective Payment System Update and Changes to the Hospital Outpatient Prospective Payment System ...................... 87 Bulletin Reader Survey Provide your Comments and Feedback on the Medicare Part A Publication and/or our Provider Web Site ................................................................................................................ 103 Features From the Medical Director 3 he Medicare A Bulletin should be shared with all Administrative 4 T health care practitioners and General Information 5 managerial members of the General Coverage 11 provider/supplier staff. Publications issued after End Stage Renal Disease 13 October 1, 1997, are available Skilled Nursing Facility Services 14 at no-cost from our provider Comprehensive Outpatient Rehabilitation Facilities 19 Web site at www.floridamedicare.com. Hospital Services 21 Local and Focused Medical Policies 22 Routing Suggestions: Outpatient Prospective Payment Services 87 ! Medicare Manager Fraud and Abuse 92 ! Reimbursement Director Provider Audit and Reimbursement 93 ! Chief Financial Officer Electronic Data Interchange 94 ! Compliance Officer ! DRG Coordinator ! ________________ FIRST COAST ! ________________ Medicare A Health Care Financing Administration SERVICE OPTIONS, INC. ! ________________ A Newsletter for Florida Medicare Part Providers A HCFA Contracted Carrier & Intermediary Fourth Quarter 2001 Volume 3, Number 4 TABLE OF CONTENTS Table of Contents Medicare A In This Issue ................................................. 1 70450: Computerized Axial Tomography of Bulletin From the Intermediary Medical Director the Thorax ........................................ 29 70450: Computerized Axial Tomography of Vol. 3, No. 4 A Physician’s Focus the Abdomen ..................................... 31 Fourth Quarter Screening Services vs. Diagnostic Services ...... 3 84155: Serum Protein ................................. 35 2001 Administrative 85007: Complete Blood Count ..................... 38 Publications Staff About The Medicare A Bulletin ....................... 4 88141: Pap Smears ...................................... 42 92225: Ophthalmoscopy .............................. 46 Millie C. Pérez General Information 93303: Transthoracic and Doppler Pauline Crutcher Expansion of Medicare Reimbursement for Echocardiography and Doppler Shari Bailey Telehealth Services ............................... 5 Color Flow Velocity Mapping ............. 49 Bill Angel Services and Items Furnished to Prisoners ..... 7 A0430: Air Ambulance Services .................. 54 COB Contractor Fact Sheet for Providers ........ 8 The Medicare A Bulletin is G0030: Positron Emission Tomography published bimonthly by the Medical Review of Therapy Services .............. 9 (PET) Scan ..................................... 57 Medicare Publications Crossover Updates ....................................... 9 G0104: Colorectal Cancer Screening ........... 65 Department, to provide FCSO Medicare eNews Now Available to G0108: Diabetes Outpatient Self- timely and useful Web site Visitors .................................... 9 Management Training ....................... 68 information to Medicare 2001 ICD-9-CM Coding Changes .................. 9 J1561: Intravenous Immune Globulin .......... 71 Part A providers in Florida. Automated Response Unit for Medicare A J1745: Infliximab (Remicade™) .................. 77 Providers ............................................. 10 Questions concerning this J9212: Interferon ........................................ 79 publication or its contents General Coverage M0302: Cardiac Output By Electrical may be directed in writing New CLIA Waived Tests .............................. 11 Bioimpedance ................................ 82 to: Coverage and Billing of Biofeedback Training Additions and Revisions to Previously Medicare Part A for the Treatment of Urinary Incontinence . 12 Published Medical Policy Publications Expanded Coverage on Percutaneous 70450: Computerized Tomography Scan ..... 86 P.O. Box 2078 Transluminal Angioplasty ..................... 12 C1300: Hyperbaric Oxygen Therapy ............ 86 Jacksonville, FL End of Stage Renal Disease Erythropoietin for Anemia of Chronic 32231-0048 Intravenous Iron Therapy ............................. 13 Disease .......................................... 86 CPT five-digit codes, Outpatient Prospective Payment System descriptions, and other data Skilled Nursing Facility Services only are copyright 2000 by Billing for Audiologic Function Tests for Use of Modifier 25 and Modifier 27 in the American Medical Beneficiaries that Are Patients if a Hospital Outpatient Prospective Payment Association (or such other Skilled Nursing Facility (SNF) ................ 14 System .................................................... 87 date of publication of CPT). Skilled Nursing Facility Annual Update for Update to the Hospital Outpatient Prospective All Rights Reserved. Fiscal Year 2002 .................................. 14 Payment System (OPPS) .......................... 87 Applicable FARS/DFARS Clarification to Health Insurance Prospective OPPS Pass-Through Devices Categories apply. No fee schedules, Payment System (HIPPS) Coding and Guidelines ................................................ 91 basic units, relative values or related listings are included Billing Instructions ............................... 15 Fraud and Abuse in CPT. AMA does not Comprehensive Outpatient Undercover Investigation Reveals Unethical directly or indirectly Tactics ........................................................ 92 practice medicine or Rehabilitation Facility Services dispense medical services. New Temporary “Q” Codes for Splints and Provider Audit and Reimbursement AMA assumes no liability for Cast Used for Reduction of Fractures and Audit and Cost Report Settlement Expectations . 29 data contained or not Dislocations ......................................... 19 contained herein. Electronic Data Interchange Hospital Services ICD-9-CM codes and their HIPAA-AS Standard-Health Care Claim and Postacute Care Transfer Policy .................... 21 descriptions used in this Coordination of Benefits (COB) Transactions . 30 Independent Laboratory Billing for the TC of publication are copyright Physician Pathology Services to Hospital Educational Resources 2000 under the Uniform Patients ............................................... 21 Copyright Convention. All The Patient Friendly Advisory ......................... 95 rights reserved. Medical Policies www.floridamedicare.com—Florida Medicare’s Provider Web Site .................................. 96 Third-party websites. This Medical Policy Table of Contents ................. 22 document contains Use of the American Medical Association’s Medicare Educational Materials Available Now 96 references to sites operated (AMA’s) Current Procedural Terminology Medicare Educational Material Order Form ...... 97 by third parties. Such (CPT) Codes on Contractors’ Web Sites .. 22 Medicare Individual Module Order Form .......... 99 references are provided for Order Form - Part A Materials .................... 101 your convenience only. Final Medical Policies Reader Survey — Medicare A Bulletin .......... 103 BCBSF and/or FCSO do not 10060: Incision and Drainage of Abscess of control such sites and are not Skin, Subcutaneous and Accessory Other Information responsible for their content. Structures ........................................ 23 Addresses, Medicare Web sites, The inclusion of these 55873: Cryosurgical Ablation of the Prostate .... 25 and Phone Numbers ........................... 111 references within this 67221: Ocular Photodynamic Therapy (OPT) document does not suggest any endorsement of the with Verteporfin ................................ 27 material on such sites or any association with their operators. 2 The Florida Medicare A Bulletin Fourth Quarter 2001 FROM THE INTERMEDIARY MEDICAL DIRECTOR A PHYSICIAN’S FOCUS Screening Services vs. Diagnostic Services he July issue of the American Journal of Preventive Medicine Tfeatured a study that prioritized 30 preventive services recommended for average risk patients based on the service health benefits and cost effectiveness (Am J Prev Med 2001, 21:1:1-9). For example, immunizations for children and anti-smoking counseling for adults ranked highly in medical effectiveness (deaths or injuries avoided in quality-adjusted life years (QALYs)) if the preventive service reached the population) and cost effectiveness (net cost of preventive service divided by the QALYs saved). Some screening services ranked highly and others did not. The Medicare program,