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January 25, 2018

Four Tests Added to List of CLIA Waived Tests

In early January, the Centers for Medicare and Medicaid Services (CMS) announced new waived tests... Learn More

New and Revised Vaccine Codes Added to 2018 CPT Code Book

The American Medical Association (AMA) added and revised several vaccine CPT codes for its 201... Learn More

OIG Recommends Measures for Curbing Opioid Misuse and Fraud

Office of Inspector General testimony before the House Committee on Ways and Means in January ... Learn More

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Medical Coding News Archives

CPT® and HCPCS changes impact observation and recovery

June 13, 2017:

After a relatively quiet first quarter 2017, the Centers for Medicare and Medicaid Services (CMS) issued several code changes affecting CPT® and HCPCS code sets. All changes were effective April 1. Have you noted these changes?

Code changes directly affect providers and suppliers who submit claims to Medicare Administrative Contractors (MACs), including home health and hospice MACs. Modifications are for Current Procedural Terminology (CPT®) and Healthcare Common Procedural Terminology Coding System (HCPCS) codes.

For detailed descriptions of code changes, read the latest Chargemaster Corner newsletter. Below is a broad look at what has been altered and introduced:

Observation and Recovery

  • Claim for observation services must include one of the following:
  • - Type A or B ER visit: CPT® codes 99281-99285 or HCPCS codes G0380-G0834 - Clinic visit: HCPCS code G0463 - Critical care: CPT® code 99291 - Direct referral for observation: HCPCS code G0379 (APC 0633)

New Proprietary Lab Analyses (PLA) Codes

  • CPT® 0001U – Red blood cell antigen typing
  • CPT® 0002U – Oncology (colorectal), quantitative assessment of three urine metabolites
  • CPT® 0003U – Oncology (ovarian) biochemical assays of five proteins

Presumptive Drug Test Coding

  • HCPCS G Codes terminated on Dec. 31, 2016
  • CMS assigned CPT® codes 80305, 80306 and 80307 effective Jan. 1, 2017

Argus Retinal Prosthesis Add-on

  • HCPCS code C1842 established in January to resolve claims processing issue for ambulatory surgery centers (ASCs)
  • Should not be reported on institutional claims by hospital outpatient providers

Use of Revenue Code 636

  • Drug administration claims submitted to fiscal intermediaries (FIs) must be billed under revenue code 0636 unless specific instructions say otherwise
  • All drugs with a “J” or “Q” code should be reported using revenue code 636. This includes “tablet” type drugs with a “J” code assignment

Optum360 publishes Chargemaster Corner quarterly. Copies can be found on the Coding Central site.

CPT is a registered trademark of the American Medical Association.


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