Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

Practice Exam

CPC Practice Exam and Study Guide Package

Practice Exam

What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

CPC Exam Review Video

Laureen shows you her proprietary “Bubbling and Highlighting Technique”

Download your Free copy of my "Medical Coding From Home Ebook" at the top left corner of this page

Practice Exam

2016 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

Tag Archives: 2015

OIG releases its FY 2015 mid-year update

OIG releases its FY 2015 mid-year update

The Office of Inspector General (OIG) released its fiscal year (FY) 2015 Mid-Year Update last week. The update summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs during the current fiscal year and beyond.

The OIG’s job is to detect fraud, waste, and abuse; identify opportunities to improve healthcare program economy; and to hold "accountable those who do not meet program requirements or who violate Federal health care laws." The OIG conducts audits and investigation, and can impose civil monetary penalties where appropriate, so its Work Plan is often of great interest to those working with federal healthcare programs. As a summary of some of the OIG’s enforcement initiatives, the Work Plan can serve as a useful resource for companies when training and when planning internal audits. 

The FY mid-year update includes several initiatives central to long-term care providers.

 

Medicare Part A billing by SNFs

The OIG will describe changes in SNF billing practices from FYs 2011 to 2013. Prior OIG work found that SNFs increasingly billed for the highest level of therapy even though beneficiary characteristics remained largely unchanged. The OIG also found that SNFs billed one-quarter of all 2009 claims in error; this erroneous billing resulted in $ 1.5 billion in inappropriate Medicare payments. CMS has made substantial changes to how SNFs bill for services for Medicare Part A stays.

CMS’ future plans include:

  • phasing in bundling options
  • continued growth and development of ACO models of reimbursement tied to outcomes and quality of care
  • the elimination of using the amount of therapy delivered as an incentive for payment
  • conducting outcome studies on therapy delivered under Medicare Part B

 

Diane Brown, director of postacute education at HCPro explains that, "These plans will likely contribute to better care and improved transitions in care as well as be linked to appropriate payment. When implemented, much of the time spent by facilities on navigating COTs and other labor intensive tasks could be eliminated."

As Kathy W. O’Neal, RN, RAC-CT, LNHA, from Crossroads Medical Management can attest to, "There were numerous changes with Part A billing practices associated with the implementation of MDS 3.0. Probably the most significant was that on the five-day assessment, projecting therapy minutes were removed. Another significant change is that a change of therapy (COT) assessment is required every seven days if a resident in a rehab RUG category that receives more or less therapy minutes and/or the number of modalities changes enough to cause the resident to fall into another RUG category. This practice was created as a response to the thought process that SNFs were being paid for a therapy that was not needed and/or provided. These changes have created a tremendous increase in the number of assessments needed, with the resulting billing rules associated that are confusing for providers. A large percentage of my time is consumed with audits and appeals associated with Part A stays, mainly Medicare replacement policies, and often it seems that the insurance companies providing the replacement policies do not understand PPS billing. It is very frustrating but has become a routine part of our industry."

 

State agency verification of deficiency corrections

The OIG will determine whether state survey agencies verified correction plans for deficiencies identified during nursing home recertification surveys. A prior OIG review found that one state survey agency did not always verify that nursing homes corrected deficiencies identified during surveys in accordance with federal requirements. Federal regulations require nursing homes to submit correction plans to the state survey agency or CMS for deficiencies identified during surveys. CMS requires state survey agencies to verify the correction of identified deficiencies through on-site reviews or by obtaining other evidence of correction.

 

Program for national background checks for long-term-care employees

The OIG will review the procedures implemented by participating states for long-term care facilities or providers to conduct background checks on prospective employees and providers who would have direct access to patients and determine the costs of conducting background checks. Further, the OIG will determine the outcomes of the states’ programs and determine whether the programs led to any unintended consequences. Section 6201 of the Patient Protection and Affordable Care Act (ACA) requires the Secretary of Health and Human Services to carry out a nationwide program for states to conduct national and state background checks for prospective direct patient access employees of nursing facilities and other long-term care providers.

The program is administered by CMS. To carry out the nationwide program, CMS has issued solicitations for grant awards. All states, the District of Columbia, and U.S. territories are eligible to be considered for a grant award. OIG is required under the ACA to submit a report to Congress evaluating this program upon its conclusion. This mandated work is ongoing, and an interim report will be issued prior to the program’s conclusion.

O’Neal approves of this initiative, saying that, "I agree with any additional background screening to ensure our residents are cared for in a safe and caring environment."

Although the OIG’s oversight extends to other programs under the U.S. Department of Health & Human Services, the majority of its resources go toward combating fraud, waste, and abuse in Medicare and Medicaid.

You can review the entire mid-year update to the 2015 Work Plan on the OIG’s website.

HCPro.com – Billing Alert for Long-Term Care

2015 MU Attestation Deadline Approaching


If you are an eligible professional participating in the Medicare EHR Incentive Program, you have until 11:59 p.m. ET on February 29, 2016 to attest Meaningful Use for 2015 EHR reporting period. 

If you are participating in the Medicaid EHR Incentive Program, please refer to your state’s website for attestation information.

If you are a Medicaid participant who is subject to Medicare penalties and you’re attesting for the first time in 2015, you can demonstrate Meaningful Use on the Medicare attestation portal by February 29th to avoid penalties in 2016 and 2017. You will still need to submit a Medicaid attestation with your state to earn incentives. If you are a returning Medicaid MU participant who is eligible for Medicare penalties but unable to meet the 30% patient volume threshold, then also you can demonstrate Meaningful Use on the Medicare attestation portal by February 29th to avoid 2017 penalties.

Medicare Attestation Portal: https://ehrincentives.cms.gov/hitech/login.action


Coding Ahead

2015 new CPT Codes for RADIATION THERAPY


Radiation therapy codes underwent significant changes for 2015. Teletherapy isodose planning and brachytherapy codes now include the basic dosimetry calculation and IMRT codes now include guidance and tracking. Also radiation treatment delivery codes were deleted in 2015.

77306  Teletherapy isodose plan; simple (1 or 2 unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s)

77307  Teletherapy isodose plan; complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s)

77316  Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s)

77317  Brachytherapy isodose plan; intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s)

77318  Brachytherapy isodose plan; complex (calculation[s] made from over 10 sources, or remote afterloading brachytherapy, over 12 channels), includes basic dosimetry calculation(s)

77385  Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple

77386  Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex

77387  Guidance for localization of target volume for delivery of radiation treatment delivery, includes intrafraction tracking, when performed

See also complete list of 2015 CPT Changes


Coding Ahead

2015 CROSSWALK FOR LAB CODES

TEST CODE DESCRIPTION OLD CPT CODE NEW CPT CODE
6MAM 6 MAM SCREEN RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
TYL ACETAMINOPHEN 82003 80329 (HCPCS G6039)
ACETAM ACETAMINOPHEN, URINE 82003 80327 (HCPCS G6039)
ACET ACETONE 84600 80320
ALC20 ALCOHOL SCREEN RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
ALC ALCOHOL, ETHYL SERUM OR PLASMA 82055 80320 (HCPCS G6040)
ALPRAZ ALPRAZOLAM (XANAX) 80154 80346 (HCPCS G6031)
ALTAMP ALTERNATE AMPHETAMINES SCREEN 80101 (HCPCS G0431) 80301 (HCPCS G0431)
AMITR AMITRIPTYLINE AND METABOLITE 80152, 80182 80335 (HCPCS G6030, G6037)
AMPH AMPHETAMINE SCREEN RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
BARBS BARBITURATE SCREEN RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
MSBAR BARBITURATES (GCMS) 82205 80345 (HCPCS G6043)
BENZLC BENZODIAZEPINE CONF (LCMSMS) 80154 80347 (HCPCS G6031)
BENZ BENZODIAZEPINE SCREEN RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
BHPVGT BILL ONLY HPV GENTOTYPE 16/18 REFLEX 87621 87625
BHPVHR BILL ONLY HPV HIGH RISK REFLEX 87621 87624
CBUPS BUPRENORPHINE CMPLNC SCRN RFLX 80101 80301 (HCPCS G0431)
BUTALB BUTALBITAL (FIORINAL) 82205 80345 (HCPCS G6043)
THCQ CANNABINOID (THC) QUANTIFICATION 82542 80349
CAN20 CANNABINOID SCREEN (20) RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
CAN50 CANNABINOIDS SCREEN (50) RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
MSTHC CARBOXY-THC (GCMS) 82542 80324
CHLORP CHLORPROMAZINE (THORAZINE) 84022 80342 (HCPCS G6057)
CLON CLONAZEPAM (CLONOPIN) 80154 80346 (HCPCS G6031)
CLORAZ CLORAZEPATE 80154 80346 (HCPCS G6031)
MSCOC COCAINE METAB (GCMS) 82520 80353 (HCPCS G6044)
COC COCAINE SCREEN RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
CDA COMPLEX DRUG ANALYSIS 80299 80377
CPMETD COMPLIANCE CONFIRM METHADONE 83840 80358 (HCPCS G6053)
KETAMS CONFIRM KETAMINE (GCMS) 82542 80357
NIC COTININE 83887 80302 (HCPCS G6055)
DESIP DESIPRAMINE 80160 80335 (HCPCS G6032)
DIAZ DIAZEPAM AND NORDIAZEPAM 80154 80346 (HCPCS G6031)
DOXMP DOXEPIN AND METABOLITE 80166 80335 (HCPCS G6034)
OPCONQ DRUGS OF ABUSE CONF, QUANT, OPIATES 83925 80364 (HCPCS G6056)
ESTF ESTROGENS, TOTAL 82679, 82670 82671
ETGU ETHYL GLUCURONIDE, UR RFLX 80101 (HCPCS G0431) 80302 (HCPCS G0431)
ETGA ETHYL GLUCURONIDE/SULFATE 83789 80321
ETHY ETHYLENE GLYCOL 82693 80320
FENTU FENTANYL/NORFENTANYL (LCMSMS) 83925 80354 (HCPCS G6056)
FLUPH FLUPHENAZINE 84022 80342 (HCPCS G6057)
FLURAZ FLURAZEPAM 82742 80346 (HCPCS G6031)
GHBMS GAMMA-HYDROXUBUTYRIC ACID SCR 82542 80375
GIBPNL GI BACTERIAL PCR PANEL 87798 x 4 87505
HPVGTY HPV GENOTYPE 16/18 87621 x 2 87625
HPVHRD HPV HIGH RISK 87621 87624
HPVWGT HPV HIGH RISK REFLEX 87621 87624
IMDES IMIPRAMINE AND METABOLITE 80174, 80160 80335 (HCPCS G6036, G6032)
IALC ISOPROPYL ALCOHOL 84600 80320
LDISO LD ISOENZYMES 83516, 83625 83625, 83615
LIB LIBRIUM AND METABOLITE 80154 80346 (HCPCS G6031)
PAPHPV LIQUID BASED PAP, PAP AND HPV Dependent on diagnosis, 87621 Dependent on diagnosis, 87624
PAP30 LIQUID PAP + HPV (RFLX 16/18) Dependent on diagnosis, 87621 Dependent on diagnosis, 87624
LOR LORAZEPAM 80154 80346 (HCPCS G6031)
MSMEP MEPERIDINE (GCMS) 83925 80362 (HCPCS G6056)
MEPU MEPERIDINE SCREEN RFLX 80101 (HCPCS G0431) 80302 (HCPCS G0431)
MEPHOB MEPHOBARBITAL 82205 80345 (HCPCS G6043)
CARMEP MEPROBAMATE 83805, 80299 80369 (HCPCS G6052), 80299
MEPROB MEPROBAMATE, URINE 83805 80302 (HCPCS G6052)
METD METHADONE RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
METDL METHAMPHETAMINE D/L ISOMERS 82542 80324 (HCPCS G6042)
MSUX METHSUXIMIDE (CELONTIN) 83858, 80299 80339 (HCPCS G6054), 80299
MALC METHYL ALCOHOL 84600 80320
NICMUR NICOTINE & METABOLITES, URINE 83887 80323 (HCPCS G6055)
NORT NORTRIPTYLINE 80182 80335 (HCPCS G6037)
OPI OPIATE SCREEN RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
BOXCOD OXYCODONE CONFIRM REFLEX TEST 83925 80364 (HCPCS G6056)
OXYS OXYCODONE SCREEN RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
PMCARI PAIN MANAGE CARI/MEPRO 80101 (HCPCS G0431) 80302 (HCPCS G0431)
PMACET PAIN MANAGEMENT ACETAMINOPHEN 80101 (HCPCS G0431) 80301 (HCPCS G0431)
PMALC PAIN MANAGEMENT ALCOHOL RFLX 82055 (HCPCS G0431) 80301 (HCPCS G0431)
PMAAMP PAIN MANAGEMENT ALT AMP RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
PBAR PAIN MANAGEMENT BARB CONFIRM 82205 80345 (HCPCS G6043)
PMBARB PAIN MANAGEMENT BARBITURATES RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
PBEN PAIN MANAGEMENT BENZ CONFIRM 80154 80347 (HCPCS G6031)
PBUP PAIN MANAGEMENT BUPRE CONFIRM 83925 80348 (HCPCS G6058)
PMBUP PAIN MANAGEMENT BUPRENORPHINE RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
PCOC PAIN MANAGEMENT COCAINE CONF 82520 80353 (HCPCS G6044)
PMCOC PAIN MANAGEMENT COCAINE RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
PMETGS PAIN MANAGEMENT ETG/ETS RFLX 80101 (HCPCS G0431) 80302 (HCPCS G0431)
PFENT PAIN MANAGEMENT FENTANYL CONF 83925 80354 (HCPCS G6056)
PMFEN PAIN MANAGEMENT FENTANYL RFLX 80101 (HCPCS G0431) 80302 (HCPCS G0431)
PMMEP PAIN MANAGEMENT MEPERIDINE RFLX 80101 (HCPCS G0431) 80302 (HCPCS G0431)
PMETC PAIN MANAGEMENT METHADONE CONF 83840 80358 (HCPCS G6058)
PMMETH PAIN MANAGEMENT METHADONE RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
PMOPI PAIN MANAGEMENT OPIATES 83925 80356, 80365, 80364 (HCPCS G6056)
PM1 PAIN MANAGEMENT PANEL 1 RFLX 80101 x 7 (HCPCS G0431), 83925 80301, 80364 (HCPCS G0431, G6056)
PM2 PAIN MANAGEMENT PANEL 2 RFLX 80101 x 10 (HCPCS G0431), 83925 80301, 80361 (HCPCS G0431, G6056)
PM3 PAIN MANAGEMENT PANEL 3 RFLX 80101 x 13 (HCPCS G0431), 83925 80301, 80364 , 80302 x 2 (HCPCS G0431, G6056)
PM4 PAIN MANAGEMENT PANEL 4 RFLX 80101 x 17 (HCPCS G0431), 83925 80301, 80364, 80302 x 6 (HCPCS G0431, G6056)
PPROC PAIN MANAGEMENT PROPOXY CONF 83925 80367 (HCPCS G6056)
PMPROP PAIN MANAGEMENT PROPOXY RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
PTHCC PAIN MANAGEMENT THC CONFIRM 82542 80349
PMTHC PAIN MANAGEMENT THC RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
PMTRAM PAIN MANAGEMENT TRAMADOL RFLX 80101 80302 (HCPCS G0431)
PALTAP PAIN MGMT ALT AMP CONFIRM 82145 80301 (HCPCS G6042)
PMAMP PAIN MGMT AMP/METHAMPHETAMINE RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
PMBENZ PAIN MGMT BEZODIAZEPINES RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
PMPCP PAIN MGMT PHENCYCLIDINE RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
PENTO PENTOBARBITAL 82205 80345 (HCPCS G6043)
PERPH PERPHENAZINE (TINLAFAR) 84022 80342 (HCPCS G6057)
PCP PHENCYCLIDINE RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
PNA2 PRENATAL ANEUPLOIDY W/SEX 84999 81420
MSPRO PROPOX/NORPROPOXYPHENE (GCMS) 82542 80367 (HCPCS G6056)
PROP PROPOXYPHENE RFLX 80101 (HCPCS G0431) 80301 (HCPCS G0431)
SAL SALICYLATES 80196 80329 (HCPCS G6038)
SYNCAN SYNTHETIC CANNABINOIDS SCREEN RFLX 80101 (HCPCS G0431) 80302 (HCPCS G0431)
MSTRAM TRAMADOL (GCMS) 82542 80373 (G6056)
TRAMU TRAMADOL SCREEN RFLX 80101 (HCPCS G0431) 80302 (HCPCS G0431)
TCA TRICYCLIC DETECTION 80101 80301 (HCPCS G0431)
VOLAT VOLATILES 84600 80320
TCA TRICYCLIC DETECTION 80101 80301 (HCPCS G0431)
VOLAT VOLATILES 84600 80320
CONFO1 CONFIRMATION BILLING – 1 80102 80375
ACETAZ ACETAZOLAMIDE 82491 80375
AMOX AMOXAPINE/ACTIVE METABOLITE 82492 80335
ARI ARIPIPRAZOLE 83789 80342
BACLQT BACLOFEN, SERUM 83789 80369
BENUQ BENZODIAZEPINES PANEL, URINE 80154 80347 (G6031)
BMSBAR BILL ONLY BARBITURATES CONFIRM
80345 (G6043)
BMSBUP BILL ONLY BUPRENORPHINE CONFIRM 80348 (G6056)
BMSCAR BILL ONLY CARI MEPR CONFIRM 80369 (G6052)
BMSCOC BILL ONLY COCAINE CONFIRM 80353 (G6044)
BMSAPX BILL ONLY EXTENDED AMPHET CONFIRM 80324 (G6042), 80359
BLSDS BILL ONLY LSD SERUM 83789 80323
BLSDU BILL ONLY LSD URINE 83789 80323
BMSMEP BILL ONLY MEPERIDINE CONFIRM 80362 (G6056)
BMSMET BILL ONLY METHADONE CONFIRM 80358 (G6053)
BMETDA BILL ONLY METHADONE CONFIRM REFLEX TEST 83840 80358 (G6053)
BMSPRO BILL ONLY NORPROPOXY CONFIRM 80367 (G6056)
BMSPCP BILL ONLY PHENCYCLIDINE CONFIRM 83992
BMSTHC BILL ONLY THC CONFIRM 80349
BMSTRA BILL ONLY TRAMADOL CONFRIM 80373 (G6056)
BRET BRETYLIUM TOSYLATE 82491 80375
CANNQS CANNABINOIDS QUANTITATION 82542 80349
CHLORS CHLORALHYDRATE 82491 82441
CHLUR CHLORALHYDRATE, URINE RANDOM 82491 82441
TAG CIMETIDINE 82491 80375
CELEX CITALOPRAM 83789 80332
CLOBAZ CLOBAZAM, SERUM OR PLASMA 80154 80339 (G6031)
CLONID CLONIDINE 83789 80375
COCQTS COCAINE AND METABOLITES 82520 80353 (G6044)
CONFO1 CONFIRMATION BILLING – 1 80102 80375
CONFO2 CONFIRMATION BILLING – 2 80102 x 2 80375
CONFO3 CONFIRMATION BILLING – 3 80102 x 3 80375
DANT DANTRIUM 80299 80369
DEXMR DEXTROMETHORPHAN/METABOLITE 82492 80362 (G6056)
DOXY DOXYLAMINE 82491 80375
DRUSER DRUG SCREEN, SERUM RFLX 80101 X 11 80301 (G0431)
DRASER DRUG/ALCOHOL SCRN, SERUM RFLX 82055, 80101 X 11 80301 X 2 (G0431, G6040)
DUL DULOXETINE 83789 80332
DYP DYPHYLLINE 82491 80329
ESCI ESCITALOPRAM 83789 80332
EXDS EXTENDED DRUG SURVEY REFLEX 80301, 80302, 80337, 80339, 80342, 80332, 80369, 80364, 80376, 80324, 80338, 80360
EZOMET EZOGABINE AND METABOLITE 83789 80339
FENSTN FENTANYL AND METABOLITE 83925 80354 (G6056)
FENTBF FENTANYL AND METABOLITE, BLOOD 83925 80354 (G6056)
FLEX FLEXERIL 83789 80369
FLUNCO FLUNITRAZEPAM & METABOLITE UA REF 80100 80304 (G0431)
LUVOX FLUVOXAMINE 82491 80332
FURUQ FUROSEMIDE QUANTITATION 83789 80375
GABAPU GABAPENTIN, URINE 80171 80355
GLIPI GLIPIZIDE 82491 80375
GLY GLYBURIDE 82491 80375
HYDROCODONE HYDROCODONE, FREE 83925 80361 (G6056)
HYDRME HYDROMORPHONE, FREE 83925 80361 (G6056)
KETACO KATAMINE & METABOLITE (REFLEXIVE) 80100 80304 (G0431)
LACOS LACOSAMIDE 83789 80339
LDLPS LDL PARTICLE SIZE 83704, 82465, 83883 83701, 83721
LETM LEFLUNOMIDE MET (THERAPEUTIC) 83789 80375
LETP LEFLUNOMIDE MET PRE PREGNANCY 83789 80375
LOXA LOXAPINE 82491 80342
LSDSCO LSD RFLX 80101 80302 (G0431)
LSDUCO LSD, URINE RFLX 80101 80302 (G0431)
LUD MAPROTILINE 82491 80335
MEP MEPERIDINE 83925 80362
MEPHE MEPHENYTOIN AND METABOLITE 82492 80339
MERCA6 MERCAPTOPURINE/METAB, BLOOD 83789 80375
METMBN METHADONE AND METABOLITE 83840 80358 (G6053)
METHA METHAQUALONE 82542 80368
RITA METHYLPHENIDATE 83789 80360
RITAUR METHYLPHENIDATE, URINE RANDOM 83789 80360
MIRTQ MIRTAZAPINE, QUANTITATION 82491 80335
MOB MOBAN 83789 80342
MOR MORICIZINE 82491 80375
NAP NAPROXEN 82491 80329
NARDIL NARDIL 82491 80338
NEFAZQ NEFAZODONE QUANTITATION 82491 80338
OPISCO OPIATES RFLX 80101 X 2 80301 (G0431)
OPIFRT OPIATES, FREE AND TOTAL, SERUM 83925 X 2 80356, 80361, 80365 X 2 (G6056 X 2)
OPIFUS OPIATES, FREE SERUM / PLASMA 83925 80356, 80361, 80365 (G6056)
OPCONQ OPIATES, SERUM QUANT 83925 80364 (G6056)
OPITSP OPIATES, TOTAL SERUM OR PLASMA 83925 80361, 80365 (G6056)
PAROX PAROXETINE 83789 80332
PREGAS PREGABALIN, SERUM OR PLASMA 83789 80366
PREGAU PREGABALIN, URINE 83789 80366
QUETQT QUETIAPINE, SERUM 83789 80342
RIS RISPERIDONE AND METABOLITE 83789 80342
RUFIN RUFINAMIDE 83789 80339
SILVER SILVER 83788 83789
SILVER.U SILVER, URINE RANDOM 83788 83789
SPAU S-PHENYLMERCAPTURIC ACID, URINE 82570, 83789 82570, 83921
TAPNUS TAPENTADOL, URINE RFLX 80101 80302 (G0431)
THIODZ THIORIDAZINE/METABOLITE QUANT 84022 80342
TOC TOCAINIDE 82491 80375
TOPIM TOPIRAMATE 83789 80201
MSTRAM TRAMADOL (GCMS) 80373 (G6056)
TRIFLU TRIFLUOPERAZINE 83789 80342
TRIMEN TRIMETHOPRIM 83789 80375
TRIMIP TRIMIPRAMINE AND METABOLITE 82492 80335
VALPFR VALPROIC ACID, FREE 80164 80165
VENLAM VENLAFAXINE AND METABOLITE 83789 80338
VERAPA VERAPAMIL, SERUM OR PLASMA 82491 80375
ZIPRA ZIPRASIDONE, SERUM OR PLASMA 83789 80342
BUPRO BUPRIOPION, SERUM OR PLASMA 80299 80338
CLOMIP CLOMIPRAMINE AND METABOLITE, SERUM 80299 80335
CUMB12 CORDSTAT 12 DRUG SCR PNL 80101 x 12 80301, 80302 x 2 (G0431)
CUM12A CORDSTAT 12 SCR W/ALC 80101 x 12, 80100 80301, 80302 x 3 (G0431, G6040)
CUMB13 CORDSTAT 13 DRUG SCR PNL 80101 x 13 80301, 80302 x 2 (G0431)
CUM13A CORDSTAT 13 SCR W/ALC 80101 x13, 80100 80301, 80302 x 3 (G0431, G6040)
CUMB5 CORDSTAT 5 DRUG SCR PNL 80101 x 5 80301 (G0431)
CUMB7 CORDSTAT 7 DRUG SCR PNL 80101 x 7 80301 (G0431)
CUMB9 CORDSTAT 9 DRUG SCR PNL 80101 x 9 80301 (G0431)
DHTT DIHYDROTESTOSTERONE, LCMSMS 82651 80327
ETHOT ETHOTOIN 80299 80339
ETG ETHYL GLUCORONIDE REFLEX TEST 80100 80301 (G0431)
FELB FELBAMATE 80299 80339
FLUOX FLUOXETINE AND METABOLITE 80299 80332
IBU IBUPROFEN 80299 80329
MEC12A MECONIUM 12 DRUG + ALC 80101 x 12, 80100 80301, 80302 x 3 (G0431, G6040)
MEC12 MECONIUM 12 DRUG SCREEN 80101 x 12 80301, 80302 x 2 (G0431)
MEC13A MECONIUM 13 DRUG + ALC 80101 x 13, 80100 80301, 80302 x 3 (G0431, G6040)
MEC13 MECONIUM 13 DRUG SCREEN 80101 x 13 80301, 80302 x 2 (G0431)
MEC5A MECONIUM 5 DRUG + ALC 80101 x 5, 80100 80301, 80302 (G0431, G6040)
MEC5 MECONIUM 5 DRUG SCREEN 80101 x 5 80301 (G0431)
MEC7 MECONIUM 7 DRUG SCREEN 80101 x 7 80301 (G0431)
MEC7A MECONIUM 7 DRUG SCRN + ALC 80101 x 7, 80100 80301, 80302 (G0431, G6040)
MEC9SC MECONIUM 9 DRUG SCREEN 80101 x 9 80301 (G0431)
NICMSP NICOTINE AND METABOLITES – CONFIRMATION 83887 80323 G6055)
OLANZ OLANZAPINE 80299 80342
ORAL10 ORAL FLUID 10 80101 x 10 80301 (G0431)
ORAL12 ORAL FLUID 12 80101 x 12 80301, 80302 x 2 (G0431)
ORAL5 ORAL FLUID 5 80101 x 5 80301 (G0431)
ORAL7 ORAL FLUID 7 80101 x 7 80301 (G0431)
ORAL9 ORAL FLUID 9 80101 x 9 80301 (G0431)
PCATMA PCA3 – PROSTATE CANCER BIOMARKER BY TRANSCRIPTION-MEDIATED AMPLIFICATION 81478 81313
PROTRI PROTRIPTYLINE, SERUM OR PLASMA 80299 80335
SERT SERTRALINE 80299 80342
THIOTH THIOTHIXENE 80299 80342
TRAZ TRAZADONE 80299 80338

Reference: http://www.paml.com/Files/Miscellaneous/CPT%20List%20for%20Website%20120514.pdf


Coding Ahead

Information Regarding the Medicare Access and CHIP Reauthorization Act of 2015


On April 14 , 2015, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015; the President is expected to sign it shortly.  This law eliminates the negative update of 21% scheduled to take effect as of April 1, 2015, for the Medicare Physician Fee Schedule.   In addition, provisions allowing for exceptions to the therapy cap, add-on payments for ambulance services, payments for low volume hospitals, and payments for Medicare dependent hospitals that expired on April 1 have been extended.  CMS will immediately begin work to implement these provisions.

In an effort to minimize financial effects on providers, CMS previously instituted a 10-business day processing hold for all impacted claims with dates of service April 1, 2015, and later.  While the Medicare Administrative Contractors (MACs) have been instructed to implement the rates in the legislation, a small volume of claims will be processed at the reduced rate based on the negative update amount.   The MACs will automatically reprocess claims paid at the reduced rate with the new payment rate.

No action is necessary from providers who have already submitted claims for the impacted dates of service.


Coding Ahead