PTNS Coding alerts

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Anonymous

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CCI 17.0 also ties your hands when you report another new 2011 Category I code: posterior tibial neurostimulator (PTNS) code 64566 (Posterior tibial neurostimulator percutaneous needle electrode, single treatment, including programming).

Column one code 64555 (Percutaneous implantation of neurostimulator electrodes; peripheral nerve [excludes sacral nerve]) — “which you’ll no longer use for PTNS coding — bundles column two code 64566 with a modifier indicator of “1.” “Therefore, one should not bill 64566 in conjunction with 64555,” Ferragamo says.

CCI also bundles the neurostimulator analysis programming column two codes 95970-95972 (Electronic analysis of implanted neurostimulator pulse generator system …) and injection and infusion codes 96369, 96365, 96372, 96374, 96375, and 96376 into 64566. These edits have a modifier indicator of “1” as well.

Column 1 code 64566 also bundles column 2 codes for moderate (conscious) sedation: 99148-99150. These edits have a modifier indicator of “0.”

You’ll also find that column 1 code 64566 bundles the following column 2 codes:
•Venipuncture, IV, infusion, or arterial puncture services represented by codes 36000, 36400-36410, 36440, 36600-36640, and 37202
•Naso- or oro-gastric tube placement (43752)
•Bladder catheterization (51701-51703).

These edits have a modifier indicator of “1.” So you can break the bundles if clinical circumstances warrant separate reporting.

CCI also bundles column 2 codes 62310-62319 and nerve block codes 64400-64450, 64483-66493, and 64510-64530 into 64566. These edits have a modifier indicator of “0,” Ferragamo warns.

Also note that CCI 17.0 bundles column one code 64566 and column two codes 76000-76001 (Fluoroscopy …), 76942 (Ultrasonic guidance for needle placement [eg, biopsy, aspiration, injection, localization device], imaging supervision and interpretation), and 76998 (Ultrasonic guidance, intraoperative). However, these edits have a modifier indicator of “1.”
 












Q. My urologist is performing the Percutaneous Tibial Nerve Stimulation (PTNS). How do I code for this?

A. The AUA has a very clear and rigorous process for requesting review of and granting our official support to new or revised codes proposed by anyone, including industry. Manufacturers must submit all research studies and other evidence available for review to our Coding and Reimbursement Committee (CRC) comprised of physician experts, who are required by the AUA to disclose all of their relationships with industry. In addition, our Coding Hotline staff conducts extensive discussions with other certified coders and consultants before making a recommendation on a choice among codes that may be ambiguous. In the case of PTNS, we all agreed that the procedure being conducted does not completely match the description of CPT code 64555 as printed in the CPT manual. For example, the code descriptor for the 64555 includes an implantation of an electrode. As a result, our advice prior to May to those seeking advice in coding PTNS was to choose between the manufacturer's recommendation (64555) or the unlisted code (64999).

In recent months, with no direct input from AUA, Medicare and other payers have looked more closely at the physician work and practice expense RVU values included in 64555 and have concluded that the procedure commonly conducted by urologists does not include that amount of work or practice expense and therefore, these payers deemed 64555 inappropriate. As you know, in South Carolina, the Medicare carrier has taken what we consider the drastic step of asking for payments back for billing of 64555 by urologists. Due to our concern that our members may be inconvenienced by further reviews and requests for payments, a review of information distributed by the manufacturer and further contact with the American Medical Association was carried out. There was enough inconsistency to officially review this procedure for proper billing practices. The issue was placed on the AUA CRC agenda for the meeting in May. Prior to the May CRC meeting, a workgroup was convened to review all the U.S. peer-reviewed published literature on PTNS. Since the code descriptor for 64555 does not adequately describe the PTNS procedure, the AUA CRC Committee voted that the proper coding should be CPT 64999 unlisted, nervous system. In addition, CRC agreed to review any evidence submitted by the manufacturer that would justify an application for a new code for this procedure within the normal process described above.

So we are advising your members to use the unlisted code 64999 and equate this to a code chosen by your physician that mirrors the work value involved. (We are not recommending any codes). Do not bill out the programming code, there is no programming involved.



http://www.auanet.org/content/practice-resources/coding-tips/qa.cfm#misc
 












http://archive.fast-edgar.com/20131107/AabodZnekr-ha8-f8-sFdne2-ua-hF/

Effective September 9, 2013, three states (MN, WI, IL with approximately 3.7 million covered lives) that were under the jurisdiction of Wisconsin Physician Services transitioned to National Government Services (or “NGS”). NGS is currently the only Medicare Administrative Contractor (MAC) out of the nine MAC’s that declines reimbursement coverage for Urgent PC. Until a new coverage policy is available, patients in the three Midwest states that transitioned to NGS during the quarter who have already started active treatment will be “grandfathered” so they may continue to receive up to 12 treatments, but new patients utilizing Urgent PC will not have reimbursement. NGS is expected to make a decision on coverage for PTNS by the end of the calendar year.

Effective October 25, 2013, five New England states (Massachusetts, Maine, Rhode Island, New Hampshire and Vermont with approximately 1.9 million covered lives) that were under the jurisdiction of National Heritage Insurance Company transitioned to NGS. Patients in the five New England states that transitioned to NGS in October who have already started active treatment will be “grandfathered” so they may continue to receive up to 12 treatments, but new patients utilizing Urgent PC will not have reimbursement.
 






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