The Centers for Medicare and Medicaid Services (CMS) has published its quarterly update (April 2005) for Hospital Outpatient Prospective Payment System (HOPPS) providers. The update contains new and revised coding information for Adenosine and clarification for coding Low Osmolar Contrast Materials (LOCM.)
Adenosine Changes
Effective April 2005, Healthcare Common Procedure Coding System (HCPCS) codes J0150 and J0152 will no longer be recognized under the hospital outpatient PPS. Hospitals will now use code C9223 to report Medicare patients¹ adenosine injections for both therapeutic and diagnostic purposes.
This HCPCS code C9223 description is per 6 mg of adenosine for both diagnostic and therapeutic uses. Hospitals should report the appropriate number of units of service to be reimbursed for the actual amount of the drug used. Providers are cautioned to code and bill for the number of units that are used and sufficiently documented. The payment rate for the new C9223 code, as published on the CMS web page (see link below), is $12.33 per 6 mg. No changes are noted regarding the other pharmacological stress agents.
Billing Clarification for Contrast Agents
Hospitals paid under the OPPS should continue reporting contrast agents, as follows:
For more information about these changes, contact your Medicare Fiscal Intermediary (FI).
CMS Transmittal 508, Change Request 3756, published on March 18, 2005 (adenosine information, page 8 item f) can be located at: http://www.cms.hhs.gov/manuals/pm_trans/R508CP.pdf
NOTE: This coding and payment change is for Medicare OPPS bills with Date of Service (DOS) on or after April 1, 2005.
CMS payment rate updates can be found at: http://www.cms.hhs.gov/providers/hopps/
