In This Issue... Screening Mammography Services Guidelines for the Proper Billing of Screening Mammography Services ......................... 10 Intravenous Immune Globulin Coverage and Payment Guidelines for IVIg for the treatment of Autoimmune Mucocutaneous Blistering Diseases............................................................................ 11 Positron Emission Tomography Scan Services Coverage for Breast Cancer and Revised Coverage Conditions for Myocardial Viability . 16 End-Stage Renal Disease July 2002 Drug Pricing Update ....................................................................................... 23 Local Medical Review Policies Final Policies and Revisions to Previously Published Policies ........................................ 27 Outpatient Prospective Payment System Important Information about the Implementation of the July 2002 Update of the Hospital Outpatient PPS ............................................................................................. 101 Bulletin Health Insurance Portability and Accountability Act Important Information on the Model Compliance Extension Plan ................................ 109 Medicare Education and Outreach Information on the Upcoming Ultimate Medicare Expo for September 10 & 11, 2002 .... 114 he Medicare A Bulletin Features Tshould be shared with all From the Medical Director ...................................... 3 health care practitioners and Administrative ......................................................... 4 managerial members of the provider/supplier staff. General Information .................................................. 5 Publications issued after General Coverage.................................................... 11 October 1, 1997, are available Critical Access Hospital Services ............................ 20 at no-cost from our provider Web site at Hospital Services .................................................... 21 www.floridamedicare.com. ESRD Services ....................................................... 23 Routing Suggestions: Local and Focused Medical Review Policies .......... 27 Medicare Manager Skilled Nursing Facility Services ........................... 100 Outpatient Prospective Payment System ............. 101 Reimbursement Director Electronic Data Interchange ................................. 109 Chief Financial Officer Educational Resources .......................................... 113 Compliance Officer DRG Coordinator ________________ ________________ A CMS Contracted Intermediary & Carrier Medicare A A Newsletter for Florida Medicare Part A Providers A Newsletter for Florida Medicare Part A ________________ Fourth Quarter 2002 Volume 4, Number 4 TABLE OF CONTENTS Table of Contents Medicare A In This Issue ............................................................... 1 77280: Therapeutic Radiology Simulation-Aided Field Bulletin Setting ...................................................... 42 From the Intermediary Medical Director 77300: Basic Radiation Dosimetry Calculation ......... 45 Vol. 4, No. 4 A Physician’s Focus 77301: Intensity Modulated Radiation Therapy (IMRT) 47 Medicare Payment of Drugs and Biologicals Furnished Fourth Quarter 77332: Treatment Devices, Design, and Construction 50 2002 incident to a Physician’s Services ............................. 3 77336: Radiation Physics Consultation ................... 53 Administrative 82607: Vitamin B-12 (Cyanocobalamin) Assay ......... 55 Publications Staff About The Medicare A Bulletin ...................................... 4 84100: Serum Phosphorus ..................................... 57 86706: Hepatitis B Surface Antibody and Surface Millie C. Pérez General Information Antigen ...................................................... 60 Shari Bailey Sulzer Inter-Op Acetabular Shell Recall Settlement ........ 5 92567: Tympanometry ........................................... 65 Bill Angel 2003 Annual Update of the International Classification 93000: Electrocardiography .................................... 67 Betty Alix of Diseases, Ninth Revision, Clinical Modification ....... 5 93025: Microvolt T-wave Alternans ........................... 70 The Medicare A Bulletin Get Paid the First Time – Reduce Your RTPs ................ 6 93724: Electronic Analysis of Pacemaker System is published bimonthly by Diabetes Self-Management Training Payment ................ 6 and Pacer Cardioverter-Defibrillator ............... 72 the Medicare Publications Billing for Pleurx Pleural ............................................... 6 93784: Ambulatory Blood Pressure Monitoring ......... 76 Department, to provide Services Subject to Home Health Consolidated Billing .... 7 95250: Continuous Glucose Monitoring System timely and useful Newsletters Will Not Be Printed Between July and (CGMS) ..................................................... 78 information to Medicare September 2002 ..................................................... 8 A0425: Ground Ambulance Services ....................... 81 Part A providers in Florida. Provider Information Available on CMS Web Site ............ 8 G0245: Peripheral Neuropathy with Loss of Protective Rebilling of Inpatient Claims .......................................... 9 Sensation (LOPS) in People with Diabetes ... 86 Questions concerning this New Patient Status Code 64 ......................................... 9 G0248: Home Prothrombin Time International publication or its contents may be directed in writing Payment Limit for Drugs and Biologicals ....................... 9 Normalized Ratio (INR) Monitoring ............... 88 to: Responses to Provider Correct Coding Initiative Questions 10 J0587: Botulinum Toxin Type B (Myobloc™) ........... 90 Billing for Screening Mammography Services ............... 10 J2820: Sargramostim (GM-CSF, Leukine®) ............ 92 Medicare Part A Overpayment Interest Rates ....................................... 10 J3490: Zoledronic Acid (Zometa®) .......................... 95 Publications Medicare Fraud Alert .................................................. 10 P.O. Box 2078 Additions and Revisions to Previously Jacksonville, FL General Coverage Published Medical Policy 32231-0048 Intravenous Immune Globulin for the Treatment of 52282: Urethral Stents ............................................ 97 Autoimmune Mucocutaneous Blistering Diseases ....... 11 71010 Chest X-ray ................................................ 97 CPT five-digit codes, Payment for Services Furnished by Audiologists .......... 12 82728: Serum Ferritin ............................................ 97 descriptions, and other data only are copyright 2001 by New CLIA Waived Tests ............................................. 12 83540: Iron ............................................................ 97 American Medical Correction to Billing for Diagnosis and Treatment of 87086: Urine Bacterial Culture ................................ 97 Association (or such other 93975: Duplex Scanning ........................................ 97 Peripheral Neuropathy with Loss of Protective date of publication of CPT). 94010: Spirometry ................................................. 97 Sensation in People with Diabetes ......................... 13 All Rights Reserved. 94240: Functional Residual Capacity or Residual Medical Nutrition Therapy Services for Beneficiaries with Applicable FARS/DFARS Diabetes or Renal Disease .................................... 14 Volume ...................................................... 98 apply. No fee schedules, Revision to HCPCS Code for Diagnosis and Treatment 94620: Pulmonary Stress Test ................................ 98 basic units, relative values or of Peripheral Neuropathy ....................................... 16 94642: Aerosolized Pentamidine Isethionate ........... 98 related listings are included Positron Emission Tomography Scans-Requirements 94760: Noninvasive Ear or Pulse Oximetry for in CPT. AMA does not for Breast Cancer and Revised Coverage Oxygen Saturation ...................................... 98 directly or indirectly Conditions for Myocardial Viability .......................... 16 95900: Nerve Conduction Studies ............................ 98 practice medicine or Coding Changes for Sodium Hyaluronate ..................... 18 J0635: Vitamin D Analogs in Chronic Renal Disease 98 dispense medical services. Rehabilitation Services for Beneficiaries with Vision J1561: Intravenous Immune Globulin ....................... 99 AMA assumes no liability for Impairment ........................................................... 18 J9999: Antineoplastic Drugs .................................. 99 data contained or not contained herein. Critical Access Hospital Services Skilled Nursing Facility Services ICD-9-CM codes and their Update to the Medicare Outpatient Code Editor ............ 20 Deactivation of Edits C7252 and C7256 ................. 100 descriptions used in this Hospital Services Outpatient Prospective Payment System publication are copyright 2000 under the Uniform Revision to Billing for Swing Bed Services under Skilled July 2002 Update of the Hospital Outpatient Copyright Convention. All Nursing Facility Prospective Payment System ........ 21 Prospective Payment System ........................... 101 rights reserved. Excluding Hospitals Providing Part B only Services from Electronic Data Interchange the Outpatient Prospective Payment System .......... 21 Third-party Web sites. This Hospital Transferring Patients to IRFs .......................... 22 HIPAA Model Compliance Extension