Tuesday, October 25, 2016

CPT code 99173, 99174 , 99183, 99199

Procedure code and Description

99173 Screening test of visual acuity, quantitative, bilateral.

99174 Instrument-based ocular screening

99199 - Unlisted special service, procedure or report


99183 – Physician attendance and supervision of hyperbaric oxygen therapy, per session.


Visual Function and Acuity Screening Services


When a preventive medicine code and a visual screening service (99172, 99173) is provided for the same patient by the same physician or other health care professional on the same date of service, the visual function and acuity screening service is eligible for separate reimbursement.

Billing Guide for 99173, 99174


Visual function screening (99172) and visual acuity screening (99173) are included in (and not separately reimbursed from) Preventive Medicine Services for members age 22 years or over. Code 99172 is included in Preventive Services for members  under age 22 years as well.

Q: Why is 99173 (screening test of visual acuity) not separately reimbursable when billed with a Preventive Medicine code?

A: Oxford considers vision screening using an eye chart to be integral to a Preventive Medicine examination in the same way that measurements of height, weight and blood pressure are integral to a Preventive Medicine examination. Therefore, vision screening using an eye chart is not reimbursed separately from  a Preventive Medicine examination.

Will vision screenings be separately allowed with Evaluation and Management (E/M) or Preventive Medicine codes?

A: No, vision CPT code 99173 (screening test of visual acuity, quantitative, bilateral) is intended to be done within the same session as an E/M or Preventive Medicine service and is not separately reimbursed, in accordance with CMS.

Covered ICD codes

 V20.2 Routine infant or child health check

* To report code 99173, you must employ graduate visual acuity stimuli that allow a quantitative estimate of visual acuity (eg, Snellen chart).

* Code 99174 is reported for instrument-based ocular screening for esotropia, exotropia, anisometropia, cataracts, ptosis, hyperopia, and myopia.

* When acuity (99173) or instrument-based ocular screening (99174) is measured as part of a general ophthalmologic service or an E/M service of the eye (eg, for an eye-related problem or symptom), it is considered part of the diagnostic examination of the office or other outpatient service code (99201–99215) and is not reported separately.

* Other identifiable services unrelated to the screening test provided at the same time are reported separately (eg, preventive medicine services).

* Failed vision screenings will most likely result in a follow-up office visit (eg, 99212–99215) linked to the diagnosis code for the reason for the failure (eg, 367.1 [myopia]); when a specific code cannot be identified, report 368.8 (other specified visual disturbance).


Definitions: 99199 - Unlisted special service, procedure or report

SH - Second concurrently administered infusion therapy

SJ - Third or more concurrently administered infusion therapy

Nursing Services

Code home IV nursing visits lasting up to two hours using CPT code 99601. Report each additional hour beyond the initial two with 99602 with the appropriate number of units.

When provided in the infusion suite of a home infusion agency, code  each nursing visit lasting up to two hours using CPT code 99199, with a narrative description. Report each additional hour beyond the initial two with 99199-52 with the appropriate number of units, in accordance with the NHIA (National Home Infusion Association) recommendations for billing


A health care provider may not require prepayment for communication concerning return to work planning, but may bill a reasonable fee for communication with any party to the claim except the employee. The health care provider may charge an insurer for communication for return to work planning using code 99199 on an itemized bill. The fee is not subject to a fee reduction. Counseling the employee about return to work is considered part of an office visit charge.

Supplementary Reports

The employer, insurer, employee, or department may request information about the nature and extent of an injury without using the HCPR or RWA. A written response to requests for information not required on the HCPR or RWA from the health care provider is considered a supplementary report. A health care provider is not required to respond to a request for  supplementary information nor is there a time limit for a response. The health care provider may charge a reasonable fee for
providing supplementary information. The charge for the supplementary report is listed using CPT code 99199 on an itemized bill and is not subject to a fee reduction



General Guide for Procedure 99183

1. CPT Code 99183 describes the physician work (presence and supervision) involved in this service. Documentation should support this.

2. Use CPT-4 code 99183 to describe both the initial and the subsequent treatments.

3. If the therapy is continued for more than two months, documentation of medical necessity must accompany the claim and it will be reviewed on a case-by-case basis.

4. CPT code 99183 applies to Non-Outpatient Prospective Payment System (Non-OPPS) providers only.

5. HPPS code C1300 applies to Part A OPPS providers only.

6. Claims for HBO of the treatment of diabetic wounds of the lower extremity require documentation of dual diagnoses. An ICD-9-CM code from either the 250.70-250.73 range or the 250.80-250.83 range (representing a diabetes-related problem) plus one of the following ICD-9-CM codes: 707.10, 707.11, 707.12, 707.13, 707.14, 707.15, or 707.19 (representing a lower extremity wound) must be reported. Claims for diabetic wounds without dual diagnoses do not meet utilization guidelines described in this coding and billing document and will be considered medically unnecessary and will be denied.

7. Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare.

8. Title XVIII of the Social Security Act, section 1862(a)(1)(A) only allows coverage and payment for those services that are considered to be medically reasonable and necessary.

Thus, chest x-rays, routine laboratory tests, routing EKGs, routine specialty consultations, other screening tests, or other testing driven by protocol are not covered.

9. Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is statutorily excluded, has no Medicare benefit category or is rendered for screening purposes.

A provider noted the LCD has HCPCS code C1300, which is a Part A code, but is missing CPT code 99183, for Part B use.

Response:

The list of CPT codes has been corrected to include CPT code 99183.

CPT/HCPCS Codes

C1300 Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval

99183 Physician attendance and supervision of hyperbaric oxygen therapy, per session CPT code 99183 is included in this policy


Comments:

A biller asked for clarification on whether a Physician Assistant or Nurse Practitioner can supervise patients for Hyperbaric Oxygen Therapy under the direction of their  supervising hyperbaric physician. The PA or NP will have met all requirements expected of the physician with documented dive experience.

Response:

No, the CPT 2010 Code Book defines this service (CPT 99183) as "Physician attendance and supervision of hyperbaric oxygen therapy, per session." This is distinct from most CPT codes since they do not use the term "physician" in their definitions. This restrictive definition of this service precludes a physician assistant or nurse practitioner from performing this service.

Medicare Payments

Medicare allowed charges of approximately $76 million dollars ($47 million paid) for HBO2 in 1998 for 15,687 beneficiaries. Outpatient reimbursement was $35 million for 6,734 beneficiaries, physicians received $18 million for 7,282 beneficiaries, approximately  $19 million was associated with a hospital stay for 8,916 beneficiaries, and nearly $5 million was allowed as part of a skilled nursing facility stay for 1,408 beneficiaries.5 HBO2 treatments generally involve a facility charge and often a charge by a physician for supervision. Procedure code 99183 is billed for physician supervision and revenue center 413 includes facility charges for HBO2. Facility reimbursement is typically included as part of the prospective payment’s diagnosis related group (DRG) payment if provided during an inpatient hospital stay or cost-based if provided by an outpatient department. Physician reimbursement is based on a fee schedule and was approximately $140 in 1998. In contrast, cost-based outpatient reimbursement varies considerably from hospital to hospital.

Cost-based reimbursement is currently being replaced with a prospective payment system for these services.

Medicare Payment Data

We identified all Medicare beneficiaries with hyperbaric treatments paid by Medicare between 1995 and 1998. Identification of a hyperbaric procedure was based on the American Medical Association’s (AMA) CPT code 99183 (hyperbaric oxygen treatment) or facility revenue center code 413 (hyperbaric). We then extracted all payments maintained in HCFA’s National Claims History (NCH), whether paid by a carrier (physician claims) or an intermediary (hospital inpatient, hospital outpatient, or skilled nursing facility claims). This data was then utilized in sample selection, provider profiling, and trending (among states and over years).

Some Providers did not provide sufficient documentation to justify Medicare

reimbursement

Billing errors and inadequate documentation account for 9 percent of beneficiaries treated with HBO2. In most cases, sufficient documentation was simply not provided. An on-site review at one of the hospitals failing to provide records resulted in recoupment action and a referral for a fraud investigation. While treatments may have been provided, the facility was unable to provide the intermediary with adequate documentation (e.g., treatment logs) in nearly all of the cases requested. In addition to documentation problems, three charts in the sample were counted as inappropriate because they billed Medicare for topical hyperbaric oxygen therapy - a procedure explicitly excluded in the reimbursement guidelines. Five charts used the 99183 code or the revenue center 413 for related  procedures other than HBO2 (e.g., basic wound care). Medical records for three charts showed that the beneficiary for whom claims were received was never treated with hyperbarics. The remainder of this group (12 charts) provided documentation, but it was not sufficient to complete the reviews.

HCPCS Coding for OIVIT


HCPCS code G9147, effective with the April IOCE and MPFSDB updates, is to be used on claims with dates of service on and after December 23, 2009, billing for non-covered OIVIT and any services comprising an OIVIT regimen.

NOTE: HCPCS codes 99199 or 94681(with or without diabetes related conditions 250.00-250.93) are not to be used on claims billing for non-covered OIVIT and any services comprising an OIVIT regimen when furnished pursuant to an OIVIT regimen. Claims billing for HCPCS codes 99199 and 94681 for non-covered OIVIT are to be returned to provider/returned as unprocessable.



 Medicare Summary Notices (MSN), Reason Codes, and Remark Codes


Contractors shall return non-covered OIVIT claims billed with HCPCS 99199 to provider/return as unprocessable.

The contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy. This CARC/RARC combination is compliant with CAQH CORE Business Scenario Two.

Group Code: CO
CARC: 16
RARC: MA66, N56
MSN: N/A

Contractors shall return non-covered OIVIT claims billed with HCPCS 94681 with or without diabetes-related conditions 250-00-250.93 to provider/return as unprocessable.

The contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy. This CARC/RARC combination is compliant with CAQH CORE Business Scenario Three.

Group Code: CO
CARC: 16
RARC: MA66, N56
MSN: N/A

Contractors shall deny claims for non-covered OIVIT and any services comprising an OIVIT regimen billed with HCPCS code G9147.

The contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy. This CARC/RARC combination is compliant with CAQH CORE Business Scenario Three.

Group Code: CO
CARC: 96
RARC: N386
MSN: 16.10

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