TMHP - Procedure Code Review

	Extracorporeal Membrane Oxygenation Procedure Code Updates Information posted November 20, 2009: Effective for dates of service on or after December 1, 2009, some provider type and place-of-service (POS) limitations will change for extracorporeal membrane oxygenation procedure codes. Click on the title to view the details. Article: Procedure code 33960 will be made a benefit as assistant surgery and may be reimbursed to nurse practitioner, clinical nurse specialist, physician assistant, and physician providers in the inpatient hospital setting. Procedure code 33960 may be reimbursed once per day. Procedure code 33960 will be denied if billed with the same date of service as procedure code 33961. Providers may refer to the 2009 Texas Medicaid Provider Procedures Manual section 36.4.14, “Extracorporeal Membrane Oxygenation (ECMO),” on page 36-37, for more information.
	Update to “Procedure Code Changes Effective for Dates of Service On or After December 1, 2009” Information posted October 30, 2009: This is an update to an article that was posted on October 9, 2009, on this website on the Code Updates – Procedure Code Review web page titled, “Procedure Code Changes Effective for Dates of Service on or After December 1, 2009.” Additional changes will be applied to some benefits that were included in the article. Click on the title to view the details.
	Update to “Third-Quarter Procedure Code Review Updates” Information posted October 16, 2009: This is an update to an article that was posted on this website on August 7, 2009, on the Code Updates – Procedure Code Review web page, titled “Third-Quarter Procedure Code Review Updates.” The article indicated that effective for dates of service on or after October 1, 2009, benefits were changing for some Texas Medicaid procedure codes, including new assistant surgery benefits and additional provider type and place of service updates. These changes have been delayed and were not effective for dates of service on or after October 1, 2009. Providers will be informed in a future notification when these changes become effective. For more information, call the TMHP Contact Center at 1-800-925-9126. Click on the title to view the original article.
	Additional Reinstated Components for Some Radiology and Laboratory Procedure Codes Information posted October 16, 2009: This is an update to an article that was posted on the TMHP website at www.tmhp.com on September 25, 2009, on the TMHP Code Updates – Procedure Code Review web page, titled, “Reinstated Components for Some Radiology and Laboratory Procedure Codes.” Effective October 1, 2009, for dates of service on or after July 1, 2009, the total component was reinstated for procedure codes 91030, 91052, and 91065 as a laboratory service instead of a radiology service. The total component and the professional interpretation component may be reimbursed as appropriate.
	Procedure Code Changes Effective for Dates of Service on or After December 1, 2009 Information posted October 9, 2009: To align with the Centers for Medicare & Medicaid Services (CMS) requirements for easy access to all Texas Medicaid fees, TMHP has completed a review of chemotherapy, computed tomography and magnetic resonance imaging, genetic testing for colorectal cancer, helicobacter pylori testing, and clinician-directed care coordination services procedure codes. Effective for dates of service on or after December 1, 2009, provider type, place of service (POS), and type-of-service (TOS) changes will be applied to some procedure codes. Click on the title to view the details.
	Third-Quarter Procedure Code Review Updates Information posted September 25, 2009: To align with the Centers for Medicare & Medicaid Services (CMS) requirements for easy access to all Texas Medicaid fees, TMHP has completed the third-quarter procedure code review. Effective for dates of service on or after October 1, 2009, provider type, place of service (POS), and type-of-service (TOS) changes will be applied to some procedure codes, including allergen immunotherapy, clofarabine injections, immune globulin injections, lung volume reduction surgery, and tetanus immune globulin. Click on the title to view the details.
	Reinstated Components for Some Radiology and Laboratory Procedure Codes Information posted September 25, 2009: This is an update to an article published in the September/October 2009 Texas Medicaid Bulletin, No. 225, titled, “Second-Quarter Procedure Code Review Updates.” Effective October 1, 2009, for dates of service on or after July 1, 2009, the total, professional interpretation, and technical components are being reinstated and may be reimbursed for some radiology procedure codes. Additional changes are being made to some of the procedure codes as well. Click on the title to view the details.
	Clinical Laboratory Claims Reprocessing for NPs, CNSs, and PAs Information posted September 25, 2009: Effective for dates of service on or after July 1, 2009, some clinical laboratory procedure codes may be reimbursed to nurse practitioners (NPs), clinical nurse specialists (CNSs), and physician assistants (PAs) in the office setting. Affected claims submitted by NPs, CNSs, and PAs with dates of service on or after July 1, 2009, will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. Click on the title to view the complete list of affected procedure codes.
	Additional Procedure Code Updates Effective July 1, 2009 Information posted September 25, 2009: This is a correction and an update to an article published on this website on September 4, 2009, titled, “Cardiac Catheterization, Transthoracic Echocardiograms, Doppler Echocardiography Claims Reprocessing.” The article incorrectly indicated that procedure code 95310 would be reprocessed. The correct procedure code to be reprocessed is 93510. Also, procedure codes 93532 and 93533 have been added to the list of procedure codes that will be reprocessed Click on the title to view the complete, corrected, and updated article.
	Update to “Second-Quarter Procedure Code Review Updates” Information posted September 11, 2009: This is an update to an article posted on this website on the TMHP Code Updates – Procedure Code Review web page on May 15, 2009, titled, “Second-Quarter Procedure Code Review Updates.” Effective for dates of service on or after July 1, 2009, procedure codes 31075, 31205, and 31420 did not become payable as assistant surgery benefits, and surgery procedure code 31717 became payable. Additionally, provider type and place of surgery changes were applied to some surgery and radiology procedure codes. Click on the title to view the updated information.