Lab Resources October 01, 2007
  October 01, 2007

In This Issue:
CMS:

California — Medi-Cal:


Quarterly Update to CCI Edits

  CMS

Transmittal: 1330 (PDF).
Effective Date: October 1, 2007

Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 13.3, Effective October 1, 2007

The current update reflects the following changes:

There are NO New CP Pairs

Modified CP Pairs:

Column
1		 Column
2		 Effective
Date		 Policy Mods Effective
Date		 Policy Mods
82270 82272   01/01/2006   More extensive procedure 0   01/01/2006   More extensive procedure 1

There are NO Deleted, CP Pairs

There are NO New Mutually Exclusive Pairs

There are NO Modified Mutually Exclusive Pairs

There are NO Deleted, Mutually Exclusive Pairs

 

Required Reporting of NPI

  CMS

Transmittal: 1328 (PDF).
Effective Date: October 01, 2007

The Department of Health and Human Services (DHHS) provided guidance regarding contingency planning for the implementation of the NPI. For some time after May 23, 2007, Medicare Fee for Service (FFS) will allow continued use of legacy numbers (Unique Physician Identification Numbers (UPINs) and Provider Identification Numbers (PINs)), as well as accepting transactions with only NPIs. The effective date for providers to use only the NPI only on claims and to cease entering UPINs and PINs will be officially announced at a later date.

 

Report Both NPI and Medicare Legacy Identifier On Claims

  CMS

Transmittal: 1328 (PDF).
Effective Date: October 01, 2007

Since October 2, 2006, you have been encouraged to submit both the NPI and Medicare legacy identifier (PIN) on your claims. During this timeframe you were not penalized for invalid NPI/legacy ID combinations.

Medicare carriers will begin editing the NPI/legacy ID combinations for validity against the NPI crosswalk file. Where a match cannot be located on the crosswalk, claims will be rejected or returned to you.

When the claim is returned, you should first verify that the correct NPI was submitted. If correct, you will need to verify that your legacy identifier (PIN) number corresponds with the information on file with the National Plan and Provider Enumeration System (NPPES). NPPES data may be checked on line at: https://nppes.cms.hhs.gov.

If your NPPES information is correct and you have included and matched ALL Medicare legacy identifiers with a corresponding NPI in NPPES, but you are experiencing provider identifier problems with your claims that contain an NPI, you may need to submit a Medicare enrollment application (i.e., the CMS-855). Please contact Customer Service at 877-527-6613 if you need more information.

 

Medigap Crossover Claims

  CMS

Transmittal: 1332 (PDF).
Effective Date: October 01, 2007

Transitioning the Mandatory Medigap (“Claim-Based”) Crossover Process to the Coordination of Benefits Contractor (COBC)

CMS is transitioning its mandatory Medigap (“claim-based”) crossover process from its Part B contractors to the COBC. During the period from June through September 2007, CMS’ Coordination of Benefits Contractor (COBC) will sign national crossover agreements with Medigap claim-based crossover insurers and will assign new 5-digit Coordination of Benefits (COBA) Medigap claim-based crossover identifiers to these entities for inclusion on incoming Medicare claims. CMS is also preparing a separate change request (CR 5662) that includes the website where your billing staffs may go to obtain the listing of new COBA Medigap claim-based identifiers for purposes of initiating Medigap claim-based crossovers. October 1, 2007 is the effective date for completing the transition of the Medigap crossover process to the COBC.

  • Effective with claims filed to Medicare on October 1, 2007:
  • You will need to make certain that claims are submitted with the appropriate identifier that begins with a “5” and contains “5” numeric digits.
  • When the claim submitted to the Medicare contractor indicates that (1) the claim contained an invalid claim-based Medigap crossover ID, the Medicare contractor will send the following standard message to you, the provider.
  • “Information was not sent to the Medigap insurer due to incorrect/invalid information you submitted concerning the insurer. Please verify your information and submit your secondary claim directly to that insurer.”

 

Availability of UPIN Registry Website

  CMS

Transmittal: 222 (PDF).
Effective Date: October 01, 2007

Under the Medicare FFS contingency plan, UPINs and surrogate UPINs may still be used to identify ordering and referring providers and suppliers until further notice. CMS discontinued assigning UPINs on June 29, 2007, but CMS will maintain its UPIN public “look-up” functionality and Registry Website:   http://www.upinregistry.com through May 23, 2008.

 

HCFA 1550 & UB-92 Claim Forms Cutoff Date Extension

  California — Medi-Cal

Medi-Cal Home: What's New.

Beginning September 17, 2007, claims received on the old HCFA 1500 or UB-92 claim forms will be rejected and returned to the provider. Providers must submit claims on the new CMS-1500 or UB-04 claim form to avoid rejection. Medi-Cal implemented the use of the CMS-1500 and UB-04 claim forms on June 25, 2007. Unfortunately, some providers continue to submit claims on the old forms, so the Department of Health Care Services (DHCS) has authorized EDS, to continue processing claims submitted on the old HCFA 1500 or UB-92 claim forms for a limited time only. The old claim forms will continue to be processed and adjudicated appropriately only through September 16, 2007.

 

Ferritin Blood Test Diagnosis Restrictions

  California — Medi-Cal

General Medicine: Bulletin 399 (PDF).

Effective for dates of service on or after October 1, 2007, CPT-4 code 82728 is reimbursable only when billed in conjunction with one of the following ICD-9-CM diagnosis codes:

001 – 009.93 530 – 538 799.4 – 799.49
010 – 018.96 555 – 557.9 964 – 964.9
042 562.0 – 562.1 984 – 984.9
070 – 070.9 564.0 – 564.9 996 – 996.99
080 – 088.9 569.0 – 573.9 999.8 – 999.8
090 – 099.9 578 – 579.9 V08
110 – 118 581 – 586 V12.1
120 – 129 608.3 – 608.39 V12.3
140 – 165.9 626 – 627.9 V15.1 – V15.2
170 – 176.9 648 – 648.9 V43.2 – V43.4
179 – 208.99 698.0 – 698.9 V43.6 – V43.69
210 – 238.9 704.0 – 704.9 V56.0
239 – 289.9 709.0 – 709.9 V56.8
303.0 – 303.99 713 – 714.9  
306.4 – 306.49 716.0 – 716.9  
307.1 – 307.19 719.00 – 719.99  
307.5 – 307.59 773 – 773.9  
403.0 – 404.9 783.9  
425 – 428.9 790 – 790.9  

 

Gender Restrictions for Gonadotropin Follicle Stimulating and Luteinizing Hormones Diagnostic Codes

  California — Medi-Cal

General Medicine: Bulletin 399 (PDF).

In the August 2007 Medi-Cal Update, restrictions for billing CPT-4 codes 83001 (gonadotropin; follicle stimulating hormone [FSH]) and 83002 (…luteinizing hormone [LH]) were announced, including diagnostic billing code requirements. Effective for dates of service on or after September 1, 2007, additional gender restrictions apply to the diagnostic codes listed below when billed in conjunction with CPT-4 codes 83001 and 83002.

The following ICD-9-CM codes may be used only for female recipients:

174.0 – 174.9 627.0 – 627.9
220 628.0 – 628.1
256.0 752.0 – 752.49
626.0 758.6
626.9

The following ICD-9-CM codes may be used only for male recipients:

072.0 456.4
175.0 – 175.9 606 – 606.9
185 752.5 – 752.69
257.0 752.8 – 752.89
259.5 758.7

 

Fetal Fibronection Testing

  California — Medi-Cal

General Medicine: Bulletin 399 (PDF).

Effective September 1, 2007, documentation requirements for fetal fibronectin testing (CPT-4 code 82731) will change. You no longer need to document in the Reserved for Local Use field (Box 19) of the claim that the patient is symptomatic for pre-term labor. Entering ICD-9-CM diagnosis code 644.03 (premature labor after 22 weeks but before 37 weeks of completed gestation without delivery) in the diagnosis field on the claim is sufficient documentation to justify billing code 82731.

 

New Maternal Serum Screen Benefit

  California — Medi-Cal

General Medicine: Bulletin 399 (PDF).

Effective for dates of service on or after September 1, 2007, HCPCS code S3626 (maternal serum quadruple marker screen including Alpha-Fetoprotein [AFP], estriol, human Chorionic Gonadotropin [hCG] and Inhibin A) replaces HCPCS code S3625 (maternal serum triple marker screen including Alpha-Fetoprotein [AFP], estriol and human Chorionic Gonadotropin [hCG]) as a Medi-Cal benefit. This test is called the Expanded AFP (XAFP) in California. The rate is set at $162.

 

Presemptive Eligibility Program Benefits

  California — Medi-Cal

General Medicine: Bulletin 399 (PDF).

Effective for dates of service on or after September 1, 2007, the following procedure codes are benefits of the Presumptive Eligibility (PE) program:

80101 Drug screen, qualitative; single drug class method
86703 Antibody, HIV-1 and HIV-2, single assay
87086 Culture, bacterial; quantitative colony count, urine
87088 Culture, bacterial; with isolation and presumptive identification of each isolate, urine
87186 Susceptibility studies, antimicrobial agent; microdilution or agar dilution

Pregnant women should be screened for asymptomatic bacteriuria at 12 to 16 weeks of gestation with codes 87086, 87088 and 87186. PE providers must not bill bacteriuria testing for pregnant women with CPT-4 code 81007 (urinalysis; bacteriuria screen, except by culture or dipstick.)

 

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