CGS Wins the Rebid for A/B MAC Jurisdiction 15CPT® +76937 NCCI Policy Manual Update
The 2024 NCCI policy manual includes an update to section H. General Policy Statements, which indicates add-on CPT® code 76937 should not be reported separately with Radiological supervision and interpretation (RS&I) codes. In full, the NCCI policy statement reads:
CMS subsequently revised the NCCI Policy Manual to remove “76937” from Chapter 9, section H. of the NCCI Policy Manual on February 14, 2024.
CMS and NCHS Announces ICD-10 Updates Effective April 2024
The Center for Medicare and Medicaid Services (CMS) and National Center for Health Statistics (NCHS) have announced the ICD-10-CM and ICD-10-PCS updates which will be effective April 1, 2024. There are two annual updates for ICD-10, October and April.
October updates are typically more extensive than the April updates. For the April 2024 ICD-10-CM update, no new diagnosis codes or coding guidelines are being implemented, only “typographical errors” being addressed during this update period. The updated code files for April 2024 are to be used for discharges and patient encounters occurring from October 1, 2023, through September 30, 2024. The ICD-10-CM files can be found on the CMS website or the CDC website. For April 2024 ICD-10-PCS update, 41 new procedure codes are being implemented. Endoscopic excision and resection of gastrointestinal organ procedures make up most of the new codes. Of interest for radiation therapy is code 00H005Z (Insertion of radioactive element, palladium-103 collagen implant into brain, open approach). This code is designated as an O.R. procedure and corresponds to MS-DRGs 023-027, 907-909 and 955. A complete listing of the new PCS codes with their corresponding MS-DRGs can be found here. With these additions, the total of ICD-10-PCS codes for 2024 is now 78,638. The updated code files for April 2024 are to be used for discharges occurring from October 1, 2023, through September 30, 2024. The ICD-10-PCS code files can be found on the CMS website. Telehealth Utilization Increases Nationally
According to FAIR Health’s Monthly Telehealth Regional Tracker, telehealth has increased usage in the U.S. healthcare market. The tracker is based on the most recent monthly data and four U.S. census regions: West, South, Northeast, and the Midwest. The data provided is identified as the top five diagnoses; top five diagnoses via asynchronous telehealth; audio-only telehealth usage, urban vs rural; percent of medical claim lines; and telehealth cost corner. Based on recent data from the privately insured population including Medicare Advantage, the largest increase in telehealth claim line volume occurred in the West, while the Midwest had the lowest increase.
Although mental health conditions remain at the top of the leading diagnoses, there was a noticeable decrease in mental health telehealth claim lines in all four regions. Following mental health conditions, acute respiratory diseases and infections diagnoses remained second. Its share of claim lines accelerated in all regions. A surplus number of COVID-19 cases re-entered the rankings in the Midwest and Northeast. The southern region showed an influx of diabetes mellitus and hypertension diagnoses. On a nationwide level, the top five diagnoses via asynchronous telehealth are hypertension, mental health conditions, diabetes mellitus, urinary tract infections, and acute respiratory diseases and infections. Hypertension trends first in all regions but the South, where it ranked second. Most of these asynchronous telehealth claim lines showed a decline, while acute respiratory diseases and infections rose during the fall season. There is an evident generational gap when it comes to appointment scheduling and navigating telehealth services. Millennials tend to be more satisfied while baby boomers have experienced lower levels of satisfaction utilizing virtual care. Telehealth has increased on a national level in every region, except the Southern region, which showed a higher usage of telemedicine in rural areas. However, research has shown that telemedicine services are being billed at a lower level of service code than in-person office visits performing the same encounter, while offering the ease of performing the virtual visit anywhere. This is despite providers’ ability to be reimbursed at a higher facility rate. Study finds ChatGPT has Potential to Improve Breast Cancer Screening Healthcare Materials
ChatGPT was launched on November 30, 2022, by AI research and development company, Open AI. Multiple researchers are discovering ChatGPT’s potential to improve healthcare materials. One study involved the analysis of ChatGPT’s ability to simplify responses to questions about breast prevention and screening. Researchers found that ChatGPT has the potential to improve both reading ease and readability of educational materials while still maintaining clinical appropriateness.
The study was led by Hana Haver MD and conducted by her team at the University of Maryland Medical Intelligent Imaging Center, in Baltimore. Study findings were published on February 2, 2024, in Radiology: Imaging Cancer. The team noted that “In the context of breast cancer screening, increasing the readability of patient-facing material has been shown to improve patient follow-up for mammography recalls.” The U.S. adult reading level average is eighth grade. The American Medical Association (AMA) and the National Institutes of Health (NIH) recommend that patient healthcare materials be written at or below a sixth-grade reading level. This level was chosen to maximize the number of patients who could understand the material. Educational materials for radiology patients are typically written at a 10th-grade reading level or higher. This decreases the number of patients who can understand the materials. When it comes to breast cancer screenings, this leads to women with low reading skills having less knowledge of mammography and decreased screening rates. Haver and her team conducted their study in March and August of 2023. They inputted 25 commonly asked patient questions about breast cancer into ChatGPT and asked the AI tool to simplify responses to a sixth-grade reading level. Examples of sample questions include, “What are the symptoms of breast cancer?” and “My radiology report says BI-RADS 5. What does that mean?” The simplified responses provided by ChatGPT were then assessed by the team for clinical accuracy and evaluated for reading ease. The team used paired t-tests and the McNemar test to compare mean reading ease, readability, and word count between the original responses and the ChatGPT simplified responses. The study findings determined that,
Findings included 92% of ChatGPT’s simplified responses were determined by the team to be clinically appropriate.
ChatGPT responses were determined to improve mean reading ease, readability, and decrease word count. While only two of the 25 original responses met the criteria for adequate reading ease, 100% of the ChatGPT responses met this same criterion. The authors concluded that ChatGPT shows significant promise as a tool that increases the accessibility of healthcare materials, but more research is needed.
The Discontinuation of Appropriate Use Criteria (AUC)
In 2014, Congress passed and signed into law the Protecting Access to Medicare Act (PAMA), which required the Centers for Medicare and Medicaid Services (CMS) to establish a program promoting the utilization of appropriate use criteria (AUC) for advanced diagnostic imaging services. The PAMA imaging AUC program required ordering providers to use a clinical decision support mechanism (CDSM), developed by provider-led entities, when ordering advanced diagnostic imaging services, such as CT, MR, and nuclear medicine exams, including PET.
The CDSM pulls information about the patient from the electronic health record (EHR), and/or the ordering physician enters information, and the CDSM provides immediate feedback about the appropriateness of the proposed imaging exam. A requirement to communicate results of the AUC consultation included the imaging facility and the interpreting radiologist. Information including which CDSM the ordering professional used, and whether the study was deemed to be appropriate, were required to be included by both the facility and the radiologist in their Medicare claims. The intent was that once the AUC program was fully implemented, imaging claims that did not include this information, or meet a defined exception, would not be paid, thus creating a “penalty” for noncompliance. The overall purpose of the AUC program was to reduce patient exposure to unnecessary radiation, reduce Medicare spending on low-value advanced imaging procedures, promote the movement towards value-based care, and be a more credible policy alternative to the inconvenient prior authorization programs in Medicare. The PAMA AUC program operated in an “educational and operations testing period” from January 1, 2020, through December 31, 2023, when the decision was made to pause the program. In the CY 2024 PFS Final Rule (pages 79256-79265), CMS rescinded the AUC regulations and paused implementation of the AUC program for reevaluation. While CMS acknowledged concerns with the real-time claims processing aspect of the program, it emphasized the agency’s continued support of the PAMA AUC program. The rule states,
All rights reserved. No part of this newsletter may be reproduced in any form whatsoever without written permission from the publisher. This newsletter may reflect coding information from the 2024 Physician’s Current Procedural Terminology (CPT® Manual). CPT is a registered trademark of the American Medical Association. CPT® five-digit codes, nomenclature and other data are copyright 2023 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT®. This product should not be considered a substitute for the codes, cross-references and exclusions located in the CPT® Manual. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for the data contained herein or not contained herein.
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