07/10/17 | New Category III codes effective Jan 1st, 2018

You will want to update your bone marrow aspiration coding for 2018 as well as some adipose-derived cell therapy for hands

New Category III codes effective Jan 1st, 2018
07/10/17 | Spinal surgery

If you do any spinal surgery you want to be aware of the Medicare changes that are taking place regarding number of levels, number of cages as well as diagnosis issues.

Spinal surgery
06/10/16 | CMS starting to list ICD-10s not covered
  Unspecified ICD-10 codes be careful
CMS starting to list ICD-10s not covered
07/09/15 | Total joint issues from CMS
  Total joint issues from CMS
Total joint issues from CMS
12/31/14 | Holding claims and fee schedule issues for 2015
  Medicare wants claims held starting Jan 1, 2015
Holding claims and fee schedule issues for 2015
08/20/14 | Medicare finally catching on that modifier 59 is not enough
Medicare finally catching on that modifier 59 is not enough
07/22/14 | Keep an eye on your private payer contracts..
Keep an eye on your private payer contracts..
07/22/14 | Proposed 2015 Fee Schedule is out
Proposed 2015 Fee Schedule is out
Archive - See All Entries


Hey check this out:
"In November, Auxilium reported that the Center for Medicare and Medicaid Services has announced that, effective January 1, 2011, J0775 will be the code used to identify XIAFLEX when billed to Medicare, Medicaid and commercial health plans for reimbursement. The XIAFLEX specific CPT code is expected to be effective in 2012"
J0775 Injection, collagenase, clostridium histolyticum, 0.01 mg - now available
Check with your Medicare payers as many have now revised and changed how they want you to bill these TWO days of treatment.

2nd Quarter 2009 HCPCS Coding Clinic:

FOR IMMEDIATE RELEASE                                               Contact: CMS Office of Media Affairs
June 25, 2010                                                                                                     (202) 690-6145


                 The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would implement key provisions in the Affordable Care Act of 2010 that expand preventive services for Medicare beneficiaries, improve payments for primary care services, and promote access to health care services in rural areas.  The proposed policies would apply to payments under the Medicare Physician Fee Schedule for services furnished on or after January 1, 2011.           

     “The rule we are proposing today is just one part of the Administration’s efforts to improve the health status of Medicare beneficiaries by expanding access to preventive services, and promoting early detection and prompt treatment of medical conditions,” said Jonathan Blum, deputy administrator and director of CMS’s Center for Medicare.  “Beginning in 2011, Medicare will cover an annual wellness visit that will offer an opportunity for the physician and patient to develop a more comprehensive approach to maintaining or improving the patient’s health and reducing risks of chronic disease.”         

     The proposed rule would implement provisions in the Affordable Care Act that will eliminate out-of-pocket costs for beneficiaries for most preventive services, including the new annual wellness visit.  This visit augments the benefits of the Initial Preventive Physical Examination (IPPE or “Welcome to Medicare Visit”) with an annual wellness visit that allows the physician and patient to develop a personalized prevention plan that includes not only the preventive services generally available to the Medicare population, but additional services that may be appropriate because of the patient’s individual risk factors.           

    The proposed rule would improve access to primary care services by implementing an incentive payment for primary care services furnished by primary care practitioners that can include physicians, nurse practitioners, clinical nurse specialists and physician assistants.  The proposed rule would also implement a payment incentive program for general surgeons performing major surgery in areas designated by the Secretary as Health Professional Shortage Areas (HPSAs), would allow physician assistants to order post-hospital extended care services in skilled nursing facilities, and would pay certified nurse midwives for their services under the Medicare Physician Fee Schedule (MPFS) at the same rates as physicians.  The proposed rule would also update other policies and payment rates for services by physicians, nonphysician practitioners (NPPs) and certain other suppliers that are paid under the MPFS during calendar year (CY) 2011.  The proposed rule projects a -6.1 percent reduction to physician payment rates in 2011 under the sustainable growth rate (SGR) formula adopted in the Balanced Budget Act of 1997.  This formula has called for an across-the-board reduction in physician payment rates every year beginning with CY 2002.  Beginning in CY 2003 through May 31, 2010, the cuts have been averted by legislative action.  On June 25, the President signed the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, which replaces the 21.3 percent reduction in physician payment rates that was required by the SGR formula for CY 2010 with a 2.2 percent payment increase for services furnished on or after June 1, 2010 through November 30, 2010. 

     “We are very concerned about the impact the continuing uncertainty about payment rates and cash flow disruptions may have on physician practices and on beneficiary access to physicians’ services,” said Blum.  “Although over 97 percent of physicians have chosen to participate in Medicare for 2010 and therefore, have agreed to accept Medicare’s payment rates as payment in full for the services they provide to beneficiaries, we are hearing more stories of physicians limiting the number of beneficiaries they will see.  We are also concerned about the diversion of scarce Medicare resources as we have to adjust our payment operations to the constantly changing legislative landscape.”        

    The proposed rule would continue recent efforts by CMS to improve the accuracy of physicians’ payment rates by implementing Affordable Care Act mandates to identify services in categories that are at significant risk for inaccurate payment and by further reducing payments in CY 2011 for diagnostic imaging equipment used in diagnostic computed tomography (CT) and magnetic resonance imaging (MRI) services.  It would also require physicians referring CT, MRI and positron emission tomography (PET) services under the in-office ancillary services exception to the physician self-referral prohibition, to notify patients that they may receive the same services from other suppliers in the area. The physician would also provide a list of alternate suppliers.                CMS will accept comments on the proposed rule until August 24, 2010, and will respond to them in a final rule to be issued on or about November 1, 2010.  Except as otherwise specified, the payment policies and rates adopted in the final rule will be effective for services on or after January 1, 2011. The proposed rule is available at:  http://www.federalregister.gov/OFRUpload/OFRData/2010-15900_PI.pdfOr  http://www.federalregister.gov/inspection.aspx#special 

See also Fact Sheets (6/25) on the proposed rule at:  www.cms.gov/apps/media/fact_sheets.asp 

Or  http://www.federalregister.gov/inspection.aspx#special

 See also Fact Sheets (6/25) on the proposed rule at:  www.cms.gov/apps/media/fact_sheets.asp




How do we bill Depomedrol 120mg since HCPCS codes J1020-J1040 are mg specific? Also, if injecting Depomedrol 80mg (J1040) in both knees, how should this be reported?



According to guidance provided by CMS for hospitals under the OPPS, hospitals now have the option to report multiple HCPCS codes for a single drug administered, or continue to bill the HCPCS code with the lowest dosage descriptor available. Therefore, your reporting options are:

·   1 unit of HCPCS code J1040, Injection, methylprednisolone acetate, 80mg, and 1 unit of HCPCS code J1030, Injection, methylprednisolone acetate, 40mg, Or

·   3 units of HCPCS code J1020, Injection, methylprednisolone acetate, 20mg, for the injection of 120mg of Depomedrol, Or

·   6 units of HCPCS code J1020, Injection, methylprednisolone acetate, 20mg, for the injection of 120mg of Depomedrol.


Report CPT code 20610, Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa), for the injection procedure performed with modifiers RT, Right, and LT, Left, where appropriate."


When I ask previously and then they published in the 3rd Quarter 2005 Coding Clinic it was (note the part that I bolded and underlined - you report per total amount of mg - not how it is packaged):

"Question 3—What is the correct way to report 30mg of Depo Medrol? There are three choices, do you report HCPCS codes J1020 x2 or J1030-52 or J1020? If you report HCPCS code J1020 that is listed by 20mg, how would you report the other 10mg?

Answer—The general rule is to bill drugs in multiples of the dosage, using the smallest J code dosage available rounded up. The coder should look at the units associated with the J code and not the units based on the way the drug is stored or stocked. Therefore, report HCPCS code J1020, Injection, methylprednisolone acetate, 20mg, with 2 units of service for the 30mg of Depo Medrol."

Attachment A  - 2010 Payment Limits for Splints and Casts