Compliance Question of the Week – General

Where can I find Medicare’s electronic clinical quality measures for next year?

I believe the answer you gave to the 5-14 general coding question is inaccurate. The question was about the correct coding of DM with a URI and CKD. Your answer gave the code for a UTI not URI.

When DM is an affecting condition for URI and the patient also has CKD, which is not treated or affecting at this encounter, do I use the combination code for hypertensive CKD or just the DM code?

I read the answer to your March 19 question, and I don’t believe the response from MedLearn completely answers the question posed by the writer. Specifically:

• The question did not mention anything about a patient being seen in different hospital departments.
• The response refers to the NCCI Policy Manual for Medicare Services, chapter XI, section B, item 4, indicating that the following guideline can be found there: “When the PICC is inserted/placed by the same department (cost center) then the IV Infusion/injection is considered a component of the procedure and not separately billable.” However, I do not see any reference in the NCCI manual guidance about the same department (cost center). For this chapter, go to file:///C:/Users/Tillie/AppData/Local/Temp/Temp1_NCCI-Policy-Manual-2018.zip/CHAP11-CPTcodes90000-99999_final%20103117.pdf.
My interpretation of the NCCI manual guidance, item 4 is as follows: It states that placement of peripheral vascular access devices is integral to IV infusion and injections and not separately reportable (e.g., 36000—introduction of needle/catheter into vein), 36410—venipuncture). This guidance is also documented in the CPT manual under the Vascular Injection Procedures section, which is referring to intravenous injection procedures into veins and arteries or catheters (e.g., peripheral IV access.)

However, per the NCCI guidance, if it is central venous access (e.g., CPT 36568, 36569), which is not routinely necessary to perform infusions/injections, this service MAY be reported separately. Central venous access procedures are different than vascular injection procedures.

So, if a PICC meets the description of a peripherally inserted central venous catheter (per the CPT manual) “to qualify as a central venous access catheter or device, the tip of the catheter/device must terminate in the subclavian, brachiocephalic (innominate) or iliac veins, the superior or inferior vena cava , or the right atrium” then when CPT codes for central venous access catheter procedures are reported with a CPT code for the IV infusion/injection administered on the same day, per the CPT manual and NCCI manual guidance and instruction it is appropriate to report it with the -59 or XU modifier regardless of the same department or revenue center.

I would appreciate your review of the initial question and my comments and any additional explanation or information you could provide on this issue.

When will CMS issue the new Medicare cards?

What ICD-10 code should be used for a routine device check done every 30 or 90 days? What ICD-10 code should be used for device checks where the patient has symptoms? What code would be assigned for the symptom?

I am looking for information from Medicare on ICD-10 changes made to the NCDs. Can you help with this?

I can no longer find the FAQs that CMS once had on its homepage. Any idea where they went?

I am starting to hear more about a CMS program called TPE. What does this stand for, and what is its purpose?

If a procedure or service has been assigned a CPT® code, does that mean Medicare will cover it?

One of our physicians sent a patient to the outpatient department to have a PICC line inserted (36568 or 36569) and have the first round of therapeutic medications (96365, 96366, 96367, 96368) on the same day. Can you please tell us if the insertion of a PICC line and the administration of the antibiotic drug can be charged on the same day with a modifier of 59 or XU?

Can you explain Medicare’s policy regarding when an inpatient admission changes to outpatient?