863XX & 873XX are two new CPT Codes For linical Lab Test

As we get ready to enter the final quarter of this year, the talk that's taking center stage now is the CPT 2012 code changes.

Two new 2012 CPT codes made its debut at the annual CMS laboratory public meeting for pricing new test codes for payment on the clinical laboratory fee schedule (CLFS). One of them is if your lab runs a single-result test for HIV-1 antigens and HIV-1/HIV-2 antibodies, you'll have a new code to use in the coming year.

More on the horizon? Not really. This year there were five codes on the agency's 'reconsideration request' list. Even though this year's meeting featured much discussion about drug test coding there were no new codes on the horizon.

In the coming year, you can expect these two just-in clinical lab test codes (although numbering is yet to be determined). These codes will provide more specific reporting for newer tests you may have added to your menu.

863XX -- Nuclear Matrix Protein 22 (NMP22), qualitative

873XX -- HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result

Drug Testing
Apart from pricing recommendations for the just-in codes, the agency heard public comments for reconsideration requests for these CPT codes 2011: G0434, G0435, 86481

Drug screen: Many commentators suggested altering G0434 to include only CLIA waived tests while coming up with a new CPT code for moderate complexity tests priced at four times G0434. The present grouping under G0434 fines clinical labs that carry out these tests using instrumented moderate complexity systems. This instrument provides clinical advantages like higher specificity that commentators said shouldn't be disheartened by coding and reimbursement.

Pricing proposal

The agency received industry input during the July 18, 2011 public meeting for the new codes. You can get CMS's proposed payments at www.cms.gov/ClinicalLabFeeSched/ and you can make comments on the recommended pricing. The agency will post final payment determinations on the same website in October this year.

Almost everyone at the public meeting expressed their willingness for crosswalks for the new CPT codes.

The AMA proposed 101 new CPT 2012 codes for molecular assays in cancer, genetics and histocompatibility all right, however CMS will not consider setting prices for those codes on the CLFS in 2012 since they were not under consideration at the public meeting.

CPT Codes 2011: A Lowdown on Femoral Popliteal Service Codes

2011 has lots of changes as far as CPT codes and guidelines for your cardiology services are concerned. Here's a lowdown on this year's CPT codes that'll stand your cardiology coding in good stead.

Among the key changes, CPT 2011 has added new codes for lower extremity endovascular revascularization which includes angioplasty, atherectomy and stenting. This year's femoral/popliteal service codes include 37224 for angioplasty, 37225 for atherectomy (and angioplasty), 37226 for stent (and angioplasty) and 37227 for stent and atherectomy (and angioplasty).

Generally, for 37224-37227, you should go for one code that represents the most intensive service carried out in a single lower extremity vessel. Say for instance when the cardiologist carries out a stent placement, atherectomy, and angioplasty in the left popliteal vessel, you should use only 37227. This code includes stent placement, atherectomy, and angioplasty. In this situation, you shouldn't use the three codes 37224, 37225, or for that matter 37226 separately or in addition to 37227.

Territory rule:

This year's CPT codes - 37220-+37235- apply to different 'territories' and each territory has its own specific set of guidelines. The codes - 37224-37227 - fall under the femoral/popliteal vascular territory.

Important rule: According to CPT, the whole femoral/popliteal territory in 1 lower extremity is taken as a single vessel for CPT coding.

As such, you should go for a single code even if the cardiologist carried out various interventions for several lesions in the political artery and in the common, deep, and superficial femoral arteries in the same leg during the same session.

In situations like this, you should use the code for the most complex service. Say for instance if the cardiologist carries out angioplasty in the left popliteal artery and atherectomy in the left common femoral, you should go for atherectomy code 37225 only.

Remember: The codes are unilateral, which means they apply to a service on a single side of the body. According to CPT, if the physician treats the identical territory in both legs at the same session, you should go for modifier 59 (Distinct procedural service) to indicate both legs are involved.

Get information on CPT codes online by signing up for a reliable medical coding resource like SuperCoder.com.

CPT 2011: Tips to Make Your 74176-74178 Use Clearer

If you have been scratching your head about the wording of new code 74178, then you are not alone. To help you in this direction, the AMA has released more details that should guide you to the proper code.

Anatomic combination is key to 74176-74178

The creation of 74176-74178 is one of the big coding changes this year. The codes are:

74176 -- Computed tomography, abdomen and pelvis; without contrast material

74177 -- with contrast material(s)

74178 -- without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions.

According to a presentation at the AMA's 2011 CPT and RBRVS Symposium in Chicago, patients often have imaging of the abdomen and pelvis carried out at the same setting, and the intent of the just-in CPT codes 2011 is to reflect this reality. Emphasis was given on the importance of using the new codes and not unbundling the abdominal and pelvic services when they are carried out at the same session. One should select just one code for the entire session.

Summary: If you are reporting an abdominal CT alone or a pelvic CT alone, your coding will remain the same this year. You will continue to choose either a pelvic code from 72192-72194 or an abdominal code from 74150-74170.

However if the abdominal and pelvic CTs are carried out at the same session, you should go for the single code from 74176-74178 that represents the services provided. You shouldn't additionally report a code from 72192-72194 (pelvis) or from 74150-74170 (abdomen).

Do not miss 74178 reporting opportunities

The guidelines are particularly helpful in deciphering how to use 74178, which would perhaps be more clearly worded as "without contrast material in one or both body regions, followed by contrast material(s) and further sections in the other body region or both body regions."

According to a chart provided by CPT, 74178 is apt when the patient has:

An abdominal CT without contrast followed by a pelvic CT with contrast

An abdominal CT without contrast and a pelvic CT without contrast followed by a pelvic CT with contrast

A pelvic CT without contrast followed by an abdominal CT with contrast

A pelvic CT without contrast and an abdominal CT without contrast followed by an abdominal CT with contrast

Pelvic and abdominal CTs without contrast followed by pelvic and abdominal CTs with contrast.

For More Information :- http://www.supercoder.com/coding-newsletters/my-radiology-coding-alert/cpt-2011-74176-74178-use-becomes-clearer-with-these-tips-article

CPT 2011 Bids Goodbye to 90465-90474, Welcomes Hello Vaccine

For combination vaccines that may involve counseling on as many as five different diseases, getting paid as though you counseled on one never seemed right, however CPT 2011 lets you capture that extra counseling work.

Multiple component vaccines (Pentacel, Kinrix, MMRV) have had an economic disincentive related to the loss of immunization administration codes with these vaccines.

As the present CPT vaccine administration codes (90465-90467) are coded per vaccine, the codes capture payment for only one counseling administration code.

CPT 2011 will delete 90465-90468. The 90471-90474 (Immunization administration ...) codes will remain.

Good news: In the coming year, you will report the immunization administration with counseling codes per component. Here's how:

Step 1: Report 90460 as vaccine adminstration W/ counseling base code

You shouldn't look at administration route when selecting which immunization adminstration with counseling code. For vaccine administration except for H1N1, you'll assign one code for each vaccine's initial component: 90460.

Step 2: Use second vaccine component with +90461

Pediatric coders can heave a sigh of relief as the complexities over deciding which 90465-90468 code to use as the base code will soon end. The CPT codes 2011 for the coming year give you only one vaccine administration with counseling base code (90460). You will report the same add on code for each additional vaccine component: +90461.

If the physician, nonphysician practitioner (NP), physician assistant (PA), or other healthcare qualified professional provides vaccine counseling to a patient less than 19 years old for a second disease/component, you will assign +90461 for the second vaccine component. You will always report +90461 in addition to 90460.

Step 3: Use units to report 3+ Administrations

You will keep using the same add-on code, +90461, for each additional vaccine component. Bill the add-on code, in addition to the number of units that represents the number of components.

For more information on CPT 2011 and the entire CPT code list, sign up for a medical coding guide like Supercoder.com