March 2006 Medicare Bulletin - Tennessee Insert
Posted March 3, 2006
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Table of Contents
TopRevision to the Medicare Claims Processing Manual Regarding Accessing Information on Use of the "AQ" Modifier
Provider Types Affected
Physicians and providers billing Medicare carriers for services provided in a Health Professional Shortage Area (HPSA)
Provider Action Needed
STOP - Impact to You
This article is based on Change Request (CR) 4182, which revises the Medicare Claims Processing Manual (Chapter 12, Sections 90.4.1.1 and 90.4.2).
CAUTION - What You Need to Know
CR4182 instructs carriers and providers to visit the Health Professional Shortage Areas (HPSAs) and Physician Scarcity Areas (PSAs) bonus payments Web pages on the Centers for Medicare & Medicaid Services (CMS) Web site for instructions on determining a census tract when self-designating through the use of the "AQ" modifier.
GO - What You Need to Do
See the Background section of this article for further details regarding this change.
Background
CMS is removing instructions on how to determine census tracts when self-designating through the use of the "AQ" modifier (physician providing a service in a HPSA) from the Medicare Claims Processing Manual (Pub. 100-04) and placing the instructions on the HPSAs and PSAs specialty Web pages. This is being done as a result of recent inquiries CMS has received and because of the volatility of data on other government Web sites that CMS depends upon to determine census tract information.
Beginning with 2005, an automated file of designations is updated on an annual basis and will be effective for services rendered with dates of service on or after January 1 of each calendar year beginning January 1, 2005, through December 31, 2005.
Physicians are allowed to self-designate throughout the year for newly designated HPSAs and HPSAs not included in the automated file based on the date of the data run used to create the file. To determine whether an "AQ" modifier is needed, physicians must review the information (referred to as "Instructions on Using the HPSA/PSA Specialty Page") provided on the CMS Web site for HPSA designations to determine if the location where they render services is, indeed, within a HPSA bonus area. The specific CMS Web site for this information is at http://new.cms.hhs.gov/HPSAPSAPhysicianBonuses.
Implementation
The implementation date for this instruction is
February 6, 2006.
Additional Information
For complete details, please see the official instruction issued to your carrier http://www.cms.hhs.gov/Transmittals/downloads/R807CP.pdf on the CMS Web site.
If you have any questions, please contact your carrier at their toll-free number, which may be found at
http://www.cms.hhs.gov/apps/contacts/ on the CMS Web site.
Ultrasound Guidance For Vascular Access (A38332)
Contractor Information
Contractor Name
CIGNA Government Services
Contractor Number
05440
Contractor Type
Carrier
Article Information
Article ID Number
A38332
Article Type
Article
Key Article
No
Article Title
CPT 76937, Ultrasound guidance for vascular
access
Primary Geographic Jurisdiction
Tennessee
Original Article Effective Date
01/01/2006
Article Revision Effective Date
Article Text
Recently we have clarified with AMA/CPT Services that this procedure code applies only to venous access procedures. The imaging includes preaccess assessment of venous patency and actual real time visualization of needle passage to the venous lumen. The descriptor for code 76937 includes all phases of actual guidance, documentation, and reporting required to perform this procedure. Use of code 76937 requires a permanent recorded image(s) of the vascular access site to be included in the patient record, as well as a documented description of the process either separately or within the procedure report. Therefore, for those instances when ultrasound is utilized only to identify a vein, mark a skin entry point, and proceed with non-guided puncture, it would not be appropriate to report code 76937 for ultrasound guidance. (Note: CPT 76942 chould not be reported with 76937.) Several of the base or primary codes for this add-on code have been applied incorrectly, as some arterial procedures have been included in the past, and more have been requested for coverage by the provider community. Effective immediately, the base codes for this ultrasound guidance procedure will be payable only for certain venous access procedures. These are:
36555 - 36585
36481
36000
36012
36005
36011
36010
36500
36145
36581
The key to appropriate code selection is documentation. Some key elements to include in the documentation for this procedure are:
Guidance used
Vein entry site
Tunneled vs non-tunneled
Subcutaneous pump, if placed
Final catheter tip position
Patient age
Coverage Topic
Diagnostic Tests and X-Rays
Doctor Office Visits
Coding Information
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.
999x
Not Applicable
Other Information
There is no Other Information for this article
Tennessee Mental Health Professional Shortage Areas (HPSAs)
Designated Geographic Areas
|
Tennessee Health Professional Shortage Areas (HPSAs)
Designated Geographic Areas
|
1 Classified as a HPSA, effective March 1, 2002.
2 No longer classified as a HPSA, effective March 1, 2002.
3 Classified as a HPSA, effective June 1, 2002.
4 Classified as a HPSA, effective February 1, 2004.
5
No longer classified as a HPSA, effective February 1, 2005
