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March 27, 2018


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Medical Coding News Archives

Quarterly ASC Update Contains New Codes, Payment Indicators

 
June 30, 2017:

On June 9, the Centers for Medicare and Medicaid Services released its quarterly payment update for ambulatory surgery center (ASC) services. The changes include several new codes and revised payment indicators, as well as additions to drugs qualifying for pass-through status and codes that are separately payable.

HCPCS Level II Codes

Three HCPCS Level II codes are separately payable effective July 1 (PI stands for payment indicator):

C9745 Nasal endoscopy, surgical; balloon dilation of eustachian tube (ASC PI J8)

C9746 Transperineal implantation of permanent adjustable balloon continence device, with cystourethroscopy, when performed and/or fluoroscopy, when performed (ASC PI J8)

C9747 Ablation of prostate, transrectal, high intensity focused ultrasound (HIFU), including imaging guidance (ASC PI G2)

New HCPCS code replaced J1725 (Injection, hydroxyprogesterone caproate, 1 mg) for Medicare reporting:

Q9986 Injection, hydroxyprogesterone caproate (Makena), 10 mg (ASC PI K2)

As a result, the PI for J1725 changed to Y5 (Nonsurgical procedure/item not valid for Medicare purposes) from K2 (Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate).

HCPCS code Q9989 (Ustekinumab, for Intravenous Injection, 1 mg) replaced C9487 with a PI of K2. Code C9487 was terminated as of June 30, 2017.

Two new HCPCS codes for drugs and biologicals with OPPS pass-through status took effect July 1:

C9489 Injection nusinersen, 0.1 mg

C9490 Injection, bezlotoxumab, 10 mg

CPT® Codes

CPT code 0474T for insertion of an anterior segment aqueous drainage device was added effective July 1. It has a PI of J8 (ASC device intensive procedures). Such devices are used to reduce intraocular pressure, often for glaucoma patients, by draining the fluid inside the eye, called the aqueous humour, to a blister behind the eyelid.

The ASC payment indicator changed for flu vaccine code 90682 (approved for the 2017/2018 flu season) from Y5 for the period January through June of 2017, to L1 (Influenza vaccine; pneumococcal vaccine. Not separately payable) beginning July 1. Note that normally packaged codes are not billed in the ASC payment system.

CPT is a registered trademark of the American Medical Association.

 

 
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