Business Briefs: Integrating New/Updated Codes Into Your Business for 2013

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Author(s): 
Kathleen D. Schaum, MS

Information regarding coding, coverage, and payment is provided as a service to our readers. Every effort has been made to ensure the accuracy of the information. However, HMP Communications and the author do not represent, guarantee, or warranty that coding, coverage, and payment information is error-free and/or that payment will be received. The ultimate responsibility for information accuracy lies with the reader.

  Hospital-based outpatient wound care departments (HOPDs) and qualified healthcare professionals should not celebrate the New Year until they have updated their charge sheets as well as their Charge Description Master and billing software. As you begin providing wound care in 2013, carefully monitor your itemized statements and remittance reports to be sure coding changes are processing correctly in your system. What follows is a review of some major coding changes that took effect on Jan. 1.

Healthcare Common Procedure Coding System (HCPCS) Codes
  The Centers for Medicare & Medicaid Services (CMS) has awarded three new “Q” codes:
    • Q4134 hMatrix,® per sq cm

    • Q4135 MEDISKIN, TM per sq cm

    • Q4136 E-Z DERM, TM per sq cm

  When using these products in wound care practice, be sure these new codes have been added to your coding and billing system. CMS has also created two new “G” codes to report the application of negative pressure wound therapy (NPWT [eg, vacuum-assisted drainage collection]).

  When using these products in wound care practice, be sure the codes shown in Table 1 below have been added to your coding and billing system. CMS has also created 42 new non-payable Always Therapy “G” codes that will provide information about the beneficiary’s functional status: 1) at the outset of the therapy episode of care; 2) at specified points during treatment; and 3) at the time of discharge. If therapists provide services in your wound care practice, be sure that the codes shown in Table 2 on page 8 have been added to your coding and billing system.

New Severity/Complexity Modifiers

  There are seven newly created severity/complexity modifiers from CMS to reflect the beneficiary’s percentage of functional impairment as determined by the therapist, physician, or non-physician practitioner furnishing the therapy services. One of the seven modifiers must be reported with each non-payable “G” code described above. Be sure that all therapy stakeholders know how to use the new severity/complexity modifiers itemized in Table 3 at left.

Updated HCPCS Codes

  CMS has also changed some cellular and/or tissue-derived products for wounds from “C” codes to “Q” codes: EpiFix,® Grafix® Core, and Grafix Prime. One product, Endoform Thermal Template,TM has gone from a “C” code to a collagen dressing code. When these products are used in wound care, be sure the codes shown in Table 4 on page 8 are corrected in all coding and billing systems.

HCPCS Code Descriptor Changes

  Several new products have been assigned to existing HCPCS codes (DermaSpan,TM InteguPly,TM Matrix TM HD, TranZgraft,® and MatriStem® PSMX, RS, and PSM). This has necessitated a change to the HCPCS code description. When these products are used in wound care, be sure the codes shown in Table 5 above have been added to all billing and coding systems and that the descriptors have been appropriately modified.

  CAUTION: Remember, the existence of a code does not guarantee coverage by various payers. All wound care stakeholders should: 1) review pertinent Local Coverage Determinations of the Medicare contractor that processes their claims and 2) verify the insurance benefits (and obtain prior authorization, if required) for patients insured by private payers, Medicare Advantage, Medicaid, etc. Also, the existence of a code does not guarantee payment. Next month we will discuss the 2013 changes in Medicare payment for HOPDs and physicians.

Kathleen D. Schaum is director of medical products reimbursement for Healthpoint Biotherapeutics and president/founder of Kathleen D. Schaum & Associates Inc., Lake Worth, FL.


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