ASCO Medicare Updates

The following CMS/Medicare updates are provided by the American Society of Clinical Oncology (ASCO).

Reporting of Hematocrit or Hemoglobin Levels for the Administration of ESAs
On May 16, 2008, the Centers for Medicare and Medicaid Services (CMS) revised their Medlearn Matters article, MM5699 for the administration of ESAs. They have deleted the words "decimal implied" in the third paragraph under the 'What You Need to Know' section that discusses reporting of the MEA segment. The values for the most recent numeric test result should be reported with decimals. All other information remains the same.

Remember, effective for services on or after January 1, 2008, you must report the most recent hemoglobin or hematocrit levels on any claim for a Medicare patient receiving: (1) ESA administrations, or (2) Part B anti-anemia drugs other than ESAs used in the treatment of cancer that are not self-administered. In addition, non-ESRD claims for the administration of ESAs must also contain one of three new Healthcare Common Procedure Coding System (HCPCS) modifiers effective January 1, 2008. An instruction sheet on reporting hematocrit/hemoglobin in conjunction with claims for Erythropoiesis-Stimulating Agents (ESAs) is available on the ASCO website.

Skilled Nursing Facility Consolidated Billing July 2008 HCPCS Code Update - CR6009
Change Request (CR) 6009 provides updates to the lists of Healthcare Common Procedure Coding System (HCPCS) codes that are excluded from the consolidated billing provision of the SNF Prospective Payment System (PPS). CR 6009 adds HCPCS code J9303 (Injection, Panitumumab, 10MG) to the Major Category III.A. Chemotherapy services FI/A/B MAC Exclusion List retroactive to January 1, 2008.

Recent Update to Medicare's Prolonged Services Coding Guidelines - CR 5972
Change Request (CR) 5972 updated the sections of the Medicare Claims Processing Manual that address Prolonged Services codes in order to be consistent with changes/deletions in codes and changes in typical/average time units in the American Medical Association Current Terminology Procedural Terminology (CPT) coding system.

The CMS updates to the Medicare Claims Processing Manual sections are as follows:

· In keeping with current Medicare payment policy for physician presence and supporting documentation, CMS defines Prolonged Services, and explains the required evaluation and management (E&M) companion codes;

· Corrected and updated the tables for threshold times to reflect code changes and current typical/average time units associated with the CPT levels of care in code families; and

· In a new Subsection (30.6.15.1 (H)), explained how to report physician visits for counseling and/or coordination of care when the visit is based on time, and when the counseling and/or coordination service is prolonged.

For more information, and to review the MedLearn Matter article, MM5972, click on the "Change Request (CR) 5972" link above.