Drug Coding Advisor: Coders need to be aware of major changes to C codes

Changes took place April 1

Hospital coders may run into some speed bumps when they begin to incorporate the latest coding changes from the Centers for Medicare and Medicaid Services (CMS).

CMS has added new C codes, which apply to new technology. As this coding area’s reimbursement also has been changed, it’s important that coders know the most appropriate way to use then new C codes.

Determining precisely which devices are intended under the new technology codes is the biggest challenge, explains Jan Rose, a coder for the Bay Area Hospital in Coos Bay, OR.

"We have to be in touch with vendors who have to get approval through CMS to apply a C code to their devices," Rose says. "With the new C codes it’s important to get it right because if you don’t, then there will be no payment for it."

Here are some of the new codes and their CMS definitions:

  • C-1751: A catheter infusion inserted peripherally, centrally, or midline, other than hemodialysis. "This code applies to Picc lines, which are used to infuse antibiotics, but you will need to ascertain whether this code also can be used for the types of catheters you supply," Rose says.
  • C-1880: Venacava filter, which is used when a patient has a pulmonary embolism. Again, this is a code that will require a little investigation to determine exactly which new technology devices will apply, Rose says.
  • C-1874: Stent — coated/covered with delivery system;
  • C-1875: Stent — coated/covered without delivery system;
  • C-1876: Stent — noncoated/noncovered with delivery system;
  • C-1877: Stent — noncoated/noncovered without delivery system.

Coders will need to determine the difference between noncoated and coated and noncovered and covered, and again this may require a telephone call to the vendor, Rose says.

  • C-1188: I-131 capsule, which is a supply of radiopharmaceutical therapeutic imaging agents with sodium iodide I-131 capsule per initial 1-5 microcuries. "You have to have the dosage documented, and you want to make sure you charge correctly the number of units so that you receive your correct payment," Rose says.

Here’s how to prevent C code problems

HIM departments can prevent problems with the new C codes by taking certain steps to make certain the codes are used properly, Rose says. Here are her suggestions:

  • The HIM department reviews the CMS updates on codes and changes the chargemaster as necessary.
  • Coders call suppliers and say, "We have this type of device, and we’re looking for a C code if there is one that can be put to it."
  • A coder or the person who handles the chargemaster fills out a requisition form that will be sent to data processing and put into the chargemaster.
  • The requisition form is completed and sent to the appropriate departments, where someone will assign a revenue code to each new charge and it will be priced.
  • Then a compliance committee, consisting of a compliance officer, a senior manager, a reimbursement specialist, and perhaps others, will determine whether or not the code is appropriate and billable before the chargemaster is completed.

Another area of new codes that may cause difficulty is in the C-8900 area. These codes will apply to Medicare, but not to other payers, so coders will have to adjust codes by manually translating CPT codes into the new C codes, Rose explains.

Here are some examples of the C codes and their CPT code equivalents:

  • C-8900: Magnetic resonance angiography; it matches the CPT 74185
  • C-8906: Magnetic resonance imaging with contrast breast bilateral; it matches CPT 76094.
  • C-8912: Magnetic resonance angiography with contrast of the lower extremity; it matches CPT 73725.
  • C-8909: Magnetic resonance angiography of the chest with contrast; it matches CPT 71555.