January 09, 2004 Print Friendly Format

 

CMS

Medicare Remittance Remark Coding Update

X12N 835 Health Care Remittance Advice Remark Codes

The Centers for Medicare & Medicaid Services (CMS) is the maintainer of the remittance advice remark codes used by Medicare. The list of remark codes is updated every March, July, and November.

The following remark codes were changed through June 30, 2003:

  • 10 New Remark Codes: N202 through N211
  • 55 Modified Remark Codes: M13 through N 169

X12N 835 Health Care Claim Adjustment Reason Codes

The Health Care Code Maintenance Committee maintains the health care claim adjustment reason codes. The Committee meets at the beginning of each X12 trimester meeting (February, June and October) and makes decisions about additions, modifications, and retirement of existing reason codes.

The following three reason codes were added in October 2003:

  • 38
  • 107
  • 3155

Reference:   Pub. 100-04, Transmittal 32, Change Request 2975.

 

Fecal-Occult Blood Tests (FOBT) – Expanded Coverage

Through an amended national coverage determination, effective for dates of service January 1, 2004 and forward, Medicare coverage is being expanded for screening for early detection of colorectal cancer by adding an additional fecal occult blood test (iFOBT, immunoassay-based) that can be used as an alternative to the existing gFOBT, guaiac-based test.

Medicare patients aged 50 and over can only receive one FOBT per year, either G0107 (gFOBT, or guaiac-based) or G0328 (iFOBT, or immunoassay-based).

Procedure G0328 is payable under the clinical lab fee schedule.

Reference:   Pub. 100-02, Transmital 3, Change Request 2996.

 

CCI

Changes to Correct Coding Edits, Version 10.0

Correct Coding Initiative (CCI) Edits Version 10.0 (Effective January 1, 2004 - March 31, 2004) will be implemented. CMS implemented national CCI Edits in 1996 for the purpose of identifying and eliminating the incorrect code of medical services.

  • No Comprehensive/Compound code pairs were deleted from the list
  • No Mutually Exclusive code pairs were deleted from the list
  • No Comprehensive/Compound code pairs were modified
  • No Mutually Exclusive code pairs were modified
  • New_CP_Pairs contains newly added Comprehensive/Component pairs
  • New_ME_Pairs contains newly added Mutually Exclusive pairs

    Eff Date Standard Policy Statement
  88112     88174     1/1/2004     Mutually exclusive procedures  
  88331     88160     1/1/2004     Misuse of Column 2 code with Column 1 code
  89225     80502     1/1/2004     Standards of medical / surgical practice
  88180     88112     1/1/2004     Standards of medical / surgical practice
  88365     88271     1/1/2004     Misuse of Column 2 code with Column 1 code
  88323     88361     1/1/2004     Misuse of Column 2 code with Column 1 code
  87269     87206     1/1/2004     HCPCS/CPT coding manual instruction / guideline
  88329     88162     1/1/2004     Misuse of Column 2 code with Column 1 code
  87800     87660     1/1/2004     HCPCS/CPT procedure code definition
  89230     80502     1/1/2004     Standards of medical / surgical practice
  88331     88162     1/1/2004     Misuse of Column 2 code with Column 1 code
  88331     88161     1/1/2004     Misuse of Column 2 code with Column 1 code
  88365     88274     1/1/2004     Misuse of Column 2 code with Column 1 code
  88332     88161     1/1/2004     Misuse of Column 2 code with Column 1 code
  88365     88358     1/1/2004     Misuse of Column 2 code with Column 1 code
  88365     88272     1/1/2004     Misuse of Column 2 code with Column 1 code
  89230     80500     1/1/2004     Standards of medical / surgical practice
  82575     82565     1/1/2004     Standards of medical / surgical practice
  88332     88160     1/1/2004     Misuse of Column 2 code with Column 1 code
  82575     81050     1/1/2004     Standards of medical / surgical practice
  88365     88273     1/1/2004     Misuse of Column 2 code with Column 1 code
  89235     80500     1/1/2004     Standards of medical / surgical practice
  88365     88275     1/1/2004     Misuse of Column 2 code with Column 1 code
  89225     80500     1/1/2004     Standards of medical / surgical practice
  88321     88361     1/1/2004     Misuse of Column 2 code with Column 1 code
  88332     88162     1/1/2004     Misuse of Column 2 code with Column 1 code
  88361     88342     1/1/2004     Most extensive procedures
  88325     88361     1/1/2004     Misuse of Column 2 code with Column 1 code
  82575     82570     1/1/2004     Standards of medical / surgical practice

The following codes were added as mutually exclusive procedures:

    Eff Date Standard Policy Statement
  88112     88174     1/1/2004     Mutually exclusive procedures                 
  88112     88143     1/1/2004     Mutually exclusive procedures  
  88112     88108     1/1/2004     Mutually exclusive procedures  
  88173     88112     1/1/2004     Mutually exclusive procedures  
  88112     88161     1/1/2004     Mutually exclusive procedures  
  88112     88175     1/1/2004     Mutually exclusive procedures  
  88112     88106     1/1/2004     Mutually exclusive procedures  
  88112     88107     1/1/2004     Mutually exclusive procedures  
  88112     88104     1/1/2004     Mutually exclusive procedures  
  88112     88142     1/1/2004     Mutually exclusive procedures  
  88112     88160     1/1/2004     Mutually exclusive procedures  
  88112     88162     1/1/2004     Mutually exclusive procedures  
  88112     88174     1/1/2004     Mutually exclusive procedures  

Notice from the CMS:

The heading "Comprehensive/Component Edits" has been changed to the heading "Column 1/Column 2 Correct Coding Edits". The table containing comprehensive/component edits also includes edits which do not involve a comprehensive/component relationship but are codes that should simply not be reported together for other reasons, for example "misuse of the code", etc. The headings have been changed to more accurately reflect the overall category of the edits within the tables and to eliminate the confusion as the result of using the term(s) "comprehensive/component".) For more detailed information, please refer to Chapter 1 - General Correct Coding Policies - Section A, Pages 1 and 2.

CCI Edits posted on Website

In an effort to improve its services, CMS has announced that it will post National Correct Coding Initiative Edits on its Website. Previously these edits were available by subscription only. The NCCI edits will be posted as a spreadsheet and will be updated quarterly:  http://cms.hhs.gov/physicians/cciedits/default.asp

 

2004 Medicare Travel Allowance Fees for Collection of Specimens

New York and New Jersey

Medicare Part B covers a specimen collection fee and travel allowance for a laboratory technician to draw a specimen from either a nursing home patient or homebound patient. There are two codes: P9603 for a per mile trip basis or code P9604 for a flat rate trip basis where the average round trip is generally less than 20 miles (or an average of 10 miles per leg of the trip). To bill either code requires documentation of the number of specimens performed per trip (for both Medicare and non-Medicare patients) to compute the Medicare prorated fee.

          New York             

          New Jersey           

     Code     

     Fee     

    

Code

Fee

P9603

$  0.83 

                        

P9603

$  0.83 

P9604

$10.62 

    

P9604

$  8.25 

Reference: Change Request 3013, Transmittal 31,  Pub. 100-20

 

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