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Medical Coding News Archives

Highlights of the HCPCS Level II Code Update

 
November 28, 2016:

The update to HCPCS Level II codes released November 4 includes wide-ranging new, revised, and deleted codes. As usual, the bulk of the changes occurred in the G code section which describes temporary procedures and professional services.

Modifiers

Below are the six new modifiers in this update:

EX Expatriate beneficiary [Modifier was effective 4/1/15, not for 2017.]

FX X-ray taken using film

PN Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital

V1 Demonstration modifier 1

V2 Demonstration modifier 2

V3 Demonstration modifier 3

ZB Pfizer/Hospira (effective 7/1/16)

Modifiers PO and Q2 were revised. The description of PO (Services, procedures and/or surgeries provided at off-campus, provider-based outpatient departments of a hospital) was changed to “Excepted service provided at an off-campus, outpatient, provider-based department of a hospital.” Modifier Q2’s description (HCFA/ORD project) changed to “Demonstration procedure/service.”

Modifier L1 (Provider attestation that the hospital laboratory test[s] is not packaged under the hospital OPPS) was deleted.

A Codes—Transportation, Medical & Surgical Supplies, Miscellaneous & Experimental

New code A4467 (Belt, strap, sleeve, garment, or covering, any type) was created to accommodate three new devices not described by the more specific, now-deleted code A4466 (Garment, belt, sleeve or other covering, elastic or similar stretchable material, any type, each). The Sleep Therapy Under Disc Decompression Device (STUDD) treats sleep disorders, particularly sleep apnea; the upper esophageal sphincter (UES) device (trade name Reza Band) is a single-patient use, noninvasive, nonsterile medical device worn during sleep to reduce symptoms of laryngopharyngeal reflux (LPR) disease; and Med Zip Up is clothing treated with Triclosan, an antibacterial and antifungal agent that helps prevent health care-associated infections and enables chemotherapy and dialysis patients to get dressed for treatment in their own homes.

New code A9285 (Inversion/eversion correction device) was created in response to a request for a code for Agilium, the trade name of an ankle foot orthosis that locks the subtalar joint to control eversion/inversion of the foot. It is an alternative to existing knee orthoses and total knee replacement surgery.

There are a few new A codes describing pharmaceuticals used in PET scans. As a replacement for deleted code C9461, CMS created new code A9515 (Choline C-11, diagnostic, per study dose up to 20 millicuries). Choline C-11 is used to detect sites of prostate cancer. Code A9587 (Gallium GA-68, dotatate, diagnostic, 0.1 millicurie) (brand name Netspot) describes a substance that traces neuroendocrine tumors, and code A9588 (Fluciclovine F-18, diagnostic, 1 millicurie) (brand name Axumin) a substance that helps flag recurrent prostate cancer.

C Codes—Temporary Hospital Outpatient Prospective Payment System

Notable among the handful of new C codes is C9140 (Injection, factor VIII [antihemophilic factor, recombinant] [Afstyla], 1 i.u.), which describes routine prophylaxis for those with hemophilia A to reduce the frequency of bleeding episodes, as well as on-demand treatment of bleeding and perioperative management of bleeding.

Of the 23 deleted C codes, 16 are new J codes, three are new Q codes, and one is a new A code. Deleted code C9743 (Injection/implantation of bulking or spacer material [any type] with or without image guidance [not to be used if a more specific code applies]) is now being cross-referenced to CPT Category III code 0438T (new for 2017 as part of phrenic nerve stimulation system).

G Codes—Temporary Procedures & Professional Services

Of particular interest among the new G codes is G0500, which describes moderate sedation for gastrointestinal endoscopy. Providers had trouble getting Medicare coverage for this service at the beginning of last year because, though CMS did cover anesthesia associated with screening colonoscopies, there was no specific code describing it.

G0500 Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate)

Also note that codes G0436 and G0437 for smoking cessation counseling have been deleted; this type of counseling should be billed under CPT codes 99406 and 99407, respectively.

J Codes—Drugs Administered Other Than Oral Method, Chemotherapy Drugs

J0570: The FDA approved buprenorphine (brand name Probuphine) in May 2016 as an “implant” to treat opioid dependence.

J0883: Argratroban is a generic anticoagulant for people who cannot take heparin.

J1130: Diclofenac (Dyloject) is an NSAID for the treatment of mild to moderate pain.

J1745: Infliximab (brand name Remicade) is an immunosuppressant that treats patients with rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, plaque psoriasis, and ulcerative colitis. It is has been revised for 2017 to exclude biosimilars.

J1942: Aripiprazole lauroxil (brand name Aristada) is an atypical antipsychotic drug for treating schizophrenia.

J2182 and J2786: Mepolizumab (brand name Nucala) and Reslizumab (brand name Cinquair) are interleukin-5 antagonist monoclonal antibody add-on drugs for the treatment of patients with severe asthma.

J2840: Sebelipase alfa (brand name Kanuma) treats patients with lysosomal acid lipase (LAL) deficiency.

J7175: Factor X (brand name COAGADEX) is indicated in adults and children (aged 12 and up) with hereditary Factor X deficiency for on-demand treatment and control of bleeding episodes.

J7179: von Willebrand factor (recombinant), (brand name Vonvendi) treats those with von Willebrand disease (VWD), an inherited bleeding disorder.

J7202: Factor IX, albumin fusion protein (brand name Idelvion) helps control and prevent bleeding episodes in patients with hemophilia B.

J7207: Factor VII (antihemophilic factor, recombinant), PEGlylated (brand name Adynovate) is indicated in adolescent and adult patients with hemophilia A.

J7209: Factor VIII (antihemophilic factor, recombinant) (brand name Nuwiq) was previously described by C9138. It is indicated for those diagnosed with hemophilia A to treat, control, and manage bleeding episodes.

J7320 and J7322: GenVisc 850, previously coded as Q9980, and Hymovis, previously C9471, treat osteoarthritic knee pain.

J7342: Ciprofloxacin (brand name Otipro), previously C9749, treats pediatric patients with otitis media with effusion who are also undergoing tympanostomy tube placement.

J8670: Rolapitant (brand name Varubi) is indicated in adults for the prevention of delayed nausea and vomiting associated with initial and repeat courses of emetogenic cancer chemotherapy.

J9034: Bendamustine HCI (brand name Bendeka) helps treat chronic lymphocytic leukemia.

J9145 and J9176: Daratumumab (brand name Drazalex) and Elotuzumab (brand name Empliciti) are used to treat relapsed multiple myeloma.

J9205: Irinotecan liposome injection (brand name Onivyde) treats metastatic pancreatic cancer.

J9295: Necitumumab (brand name Portrazza) treats metastatic squamous lung cancer.

J9325: Talimogene laherparepvec (brand name Imlygic) helps treat unresectable melanoma that recurs after initial surgery.

J9352: Trabectedin (brand name Yondelis), previously C9480, treats patients with unresectable or metastatic liposarcoma or leiomyosarcoma

K Codes— DME-MAC Temporary Codes

Of the 18 K code revisions, 17 of them had “replacement only” added to the descriptor. Code K0552 was updated to specify it represents supplies for non-insulin drug infusion pumps.

Codes K0901 and K0902 have been replaced by L1851 and L1852, respectively.

 

 
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