Q: Did the Centers for Medicare & Medicaid Services (CMS) change the definitions and/or create any new Healthcare Common Procedure Coding System (HCPCS) codes for 2008?
A: CMS added and deleted a few HCPCS codes that are pertinent to wound care providers. Table 1 identifies the deleted HCPCS codes. Note that the surgical dressings currently verified to HCPCS codes A6200-A6202 must be assigned to other HCPCS categories in order to be covered by durable medical administrative carriers. The products affected by the deletion of C9351 and J7345 received new HCPCS codes in 2008.
Table 2 illustrates the new HCPCS codes that became effective on January 1, 2008. Hospital-owned outpatient wound care departments (HOPDs) that are paid for their Medicare patients via the Ambulatory Payment Classification (APC) System and physicians who apply the dermal (substitute) tissue in their offices must update their charging systems to associate the correct HCPCS code with the brand of product applied. Table 3 compares the HCPCS codes that were valid for the various brands of products in 2007 versus 2008.
Q: Did the American Medical Association (AMA) create or change any wound care-related CPT* codes for 2008?
A: The AMA created 1 new Category III temporary code for an emerging wound care technology/procedure: 0183T-low frequency, noncontact, nonthermal ultrasound, including topical application(s), when performed, wound assessment, and instruction(s) for ongoing care, per day.
Category III codes
* allow data collection, which is not possible when unlisted codes are used;
* are critically important in the evaluation of health care delivery and the creation of medical policies surrounding emerging technologies/procedures;
* allow providers, researchers, and payers to identify emerging technology, services, and procedures for clinical efficacy, utilization, and outcomes;
* consist of 4 numbers followed by the letter "T";
* do not imply or endorse clinical efficacy, safety, or applicability to clinical practice;
* may or may not receive a Category I CPT code; Category III codes will be archived 5 years from publication or revision unless the ongoing need for the temporary code is demonstrated;
* may or may not be covered and paid by the various Medicare contractors, commercial payers, and Medicaid programs; and
* may or may not have a fee on the various Medicare payment systems.
Providers working in HOPDs that are paid by the Medicare APC payment system should note that 0183T tracks to APC Group 0015, which has a national average payment rate of $92.96/day. Note: The assignment of a payment rate to a Category III code does not guarantee that the payers will cover and pay for the technology/procedure. However, they may. Therefore, HOPDs should contact their Medicare contractor, and any other pertinent payers, to verify if 0183T is covered and payable in their system.
Physicians should note that 0183T currently does not have a fee listed on Medicare's Physician Fee Schedule. However, some Medicare contractors may cover and pay for this new emerging technology code. Like HOPDs, physicians should contact their Medicare contractor and any other pertinent payers to verify if 0183T is covered and payable in their system.
Q: Is it true that AMA revised some of the modifier descriptions?
A: Yes, several modifiers have undergone revision:
* 22 increased procedural services;
* 25 significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service;
* 32 mandated services;
* 51 multiple procedures;
* 58 staged or related procedure or service by the same physician during the postoperative period;
* 59 distinct procedural services;
* 76 repeat procedure or service by the same physician;
* 78 unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period; and
* 92 alternative laboratory platform testing.
If any of the revised modifiers are used routinely, be sure to compare carefully the descriptions in 2008 versus the descriptions that were valid in 2007. CPT 2008 Changes an Insider's View, published by AMA, provides in-depth rationales for most of the modifier changes. Providers, billers, and coders should become well educated about these modifier changes. Modifiers are as important as the CPT codes themselves.