Within the listing of 2010 HCPCS posted by CMS on November 2nd laboratorians will see two new G-codes that redefine coding of qualitative drug analysis billed to Medicare.

The 2010 HCPCS Level II update is now available in CCH Coding Comply. The updated data files became available on CMS’ website late Monday Night. It is anticipated that this update will be released in the HCPCS and CPT electronic code book in the Coding Suite and RRS sometime next week. When complete, a link will be provided in the “Hot Topics” box on the Welcome page of the Coding Suite.

CMS has determined that open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and open and laparoscopic biliopancreatic diversion with duodenal switch in Medicare beneficiaries who have type 2 diabetes mellitus (T2DM) and a body mass index (BMI) less than 35 is no longer considered reasonable and necessary. It has been determined that these same procedures do improve health in patients with T2DM with a BMI greater than 35 so they are still considered reasonable and necessary in those situations.

The 2009 HCPCS level II annual update has been released! This update includes approximately 140 new codes, 178 modified codes and 73 deleted codes.

According to CMS FAQ #8734:

An MUE (Medically Unlikely Edit) is a unit of service (UOS) edit for a Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) code for services rendered by a single provider/supplier to a single beneficiary on the same date of service. The ideal MUE is the maximum unit of service that would be reported for a HCPCS/CPT code on the vast majority of appropriately reported claims. The MUE program provides a method to report medically reasonable and necessary UOS in excess of an MUE.

A smart user who has access to both the CCH Reimbursement Toolkit Hospital Outpatient PPS Calculator and the MediRegs APC Grouper & Calculator in RRS/Plus has asked:
What is the difference between these 2 calculators?
I thought I’d share the summary with MediBloggers. Note that you’ll see reference here to the exciting new Coding & Audit Suites which will be available shortly.

There are 2 APC Calculators Available. Let me summarize them for you here: