General
The following FAQs were retired in June 2007.
- What is the correct way to code Oxaliplatin?
- Where can I find out more information on these codes?
- How should Oxaliplatin be billed?
- Can you give an example how to accurately bill oxaliplatin?
- What is the physician's involvement for cardiac rehab?
- What is meant by `in the exercise program area'?
- A patient had a coronary bypass surgery in 1998, can they participate in Cardiac Rehab?
- Has CMS made any updates to the National Coverage Determination (NCD) 100-3?
- Where can I learn more about Cardiac Rehabilitation?
- Does the rationale for Intensity Modulated Radiotherapy (IMRT) combined with conventional radiation have to be in the documentation when billing for both IMRT treatments at the same time as conventional radiation treatments?
- Are initials in a physics check box sufficient on the daily radiation treatment flow sheet for continuing physics consultation (HCPC code 77336) when performing this procedure?
- What are the correct HCPC codes for billing CyberKnife®?
What is the correct way to code Oxaliplatin?
J 9263 is for injection, Oxaliplatin per 0.5mgDate Posted: 10/27/2005, Date Reviewed/Revised: 06/15/2007
Where can I find out more information on these codes?
The coding description for Oxaliplatin can be found in a 2006 HCPCS Level II manual.
Date Posted: 10/27/2005, Date Reviewed/Revised: 06/15/2007
How should Oxaliplatin be billed?
Oxaliplatin should be billed using the correct HCPC code for the medication that was administered and the correct number of units should be entered for the dose that was administered.
Date Posted: 10/27/2005, Date Reviewed/Revised: 06/15/2007
Can you give an example how to accurately bill oxaliplatin?
Yes. For example, the patient received 180 mgs. of oxaliplatin. The correct HCPC code to use in this example is J9263. The correct number of units of Oxaliplatin is determined by the following calculation: 180 mgs./0.5mg = 360 units.
Date Posted: 10/27/2005, Date Reviewed/Revised: 06/15/2007
What is the physician's involvement for cardiac rehab?
The physician fulfills two roles in cardiac rehab. The first is direct supervision and the second is “incident-to”.
"Direct Supervision": The physician must be a) in the exercise program area and b) immediately available and accessible for an emergency at all times the exercise program is conducted. It does not require the physician be physically present in the exercise room itself. The supervision requirement would not be met by a physician who is involved in an activity (e.g. cardiac catheterization, another emergency) or is too remote from the exercise program area that would prevent him/her from being immediately available and accessible. Each provider should insure that protocols are established, posted, and verified to insure that a designated physician(s) fulfills this requirement.
"Incident to": In order to be covered under the ‘incident-to’ benefit in an outpatient hospital department, services must be furnished as an integral, although incidental part of a physician’s professional service in the course of diagnosis or treatment of an illness or injury. The benefit does not require that a physician perform a personal professional service on each occasion of service by a non-physician. However, during any course of treatment rendered by auxiliary personnel, the physician must personally see the patient periodically and sufficiently often to assess the course of treatment and the patient’s progress and, where necessary, to change the treatment program.
Date Posted: 02/03/2006, Date Reviewed/Revised: 06/15/2007
What is meant by `in the exercise program area'?
The supervision requirement is met when the physician is in such proximity to the CR exercise area that he/she can respond as noted in ‘b’ in question 2. The supervision requirement would not be met by a physician who is so physically displaced from the exercise program area preventing him/her from being immediately available and accessible.
Date Posted: 02/03/2006, Date Reviewed/Revised: 06/15/2007
A patient had a coronary bypass surgery in 1998, can they participate in Cardiac Rehab?
Medicare coverage of cardiac rehabilitation is considered reasonable and necessary for patients with a clear medical need, who are referred by their attending physician and have had coronary bypass surgery. There is no time limit for the surgery. The guidelines for cardiac rehab services can be found in CMS Pub. 100-3 §20.10.
Date Posted: 02/03/2006, Date Reviewed/Revised: 06/15/2007
Has CMS made any updates to the National Coverage Determination (NCD) 100-3?
Effective for services performed on or after March 22, 2006 CMS is updating section 20.10, to include additional clinical indications for which cardiac rehabilitation services are covered. The NCD Manual now includes a comprehensive description of the services that must be provided as part of a comprehensive cardiac rehabilitation program, extends the window of time during which the services must be provided and restructures the language for clarity. Medicare coverage of cardiac rehabilitation programs is considered reasonable and necessary only for patients who: (1) have a documented diagnosis of acute myocardial infarction within the preceding 12 months; or (2) have had coronary bypass surgery; or (3) have stable angina pectoris; or (4) have had heart valve repair/replacement; or (5) have had percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting; or (6) have had a heart or heart-lung transplant.
The Implementation Date given to the Fiscal Intermediaries was 6/21/2006. The guidelines for cardiac rehab services can be found in CMS Pub. 100-3 §20.10.
Date Posted: 02/03/2006, Date Reviewed/Revised: 06/15/2007
Where can I learn more about Cardiac Rehabilitation?
- The web link to the Summary if changes for NCD 100-3 follows: http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=20.10&ncd_version=2&basket=ncd%3A20%2E10%3A2%3ACardiac+Rehabilitation+Programs
- Publication 100-03, section 20.10 for further coverage guidelines
- 2006 MLN Matters Article
- Cross-references for the definition of physician supervision are outlined in the Code of Federal Regulations (CFR) at 42 CFR 410.26(a)(2): Main Page
Date Posted: 04/11/2006, Date Reviewed/Revised: 06/15/2007
- The web link to the Summary if changes for NCD 100-3 follows: http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=20.10&ncd_version=2&basket=ncd%3A20%2E10%3A2%3ACardiac+Rehabilitation+Programs
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Yes, the rationale for the combination treatment of IMRT and convention radiation treatment is expected to be in the oncologist’s consultation to support medical necessity for IMRT and conventional radiation treatments.
Date Posted: 02/23/2006, Date Reviewed/Revised: 06/15/2007
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Yes Initials and/or Physician's signatures are acceptable. The professionals name with credentials should be in the record (i.e., John Doe, Ph.D.) to document a physics consultation.
Date Posted: 02/23/2006, Date Reviewed/Revised: 06/15/2007
What are the correct HCPC codes for billing CyberKnife®?
The correct HCPC codes used when billing CyberKnife include:
- HCPC 0082T - Stereotatic body radiation therapy, one or more treatment areas, per day.
- HCPC 0083T – Stereotactic radiation therapy, treatment management, per day.
Date Posted: 02/23/2006, Date Reviewed/Revised: 06/15/2007