As with all types of medical establishments, skilled nursing facilities, often shortened to just SNF, saw several new updates with the beginning of the new calendar year. One of the biggest of these is the set of updates from the annual SNF consolidated billing file, which lists the new codes that have been introduced for 2018 a well as which codes will be excluded from Medicare Part A coverage. According to AAPC, this annual update contains all codes that were used to edit claims submitted to Part A and Part B MACs, or Medicare administrative contractors.

According to the Centers for Medicare & Medicaid Services, these new codes are divided into five distinct categories:

  • Major Category I – Exclusion of services beyond the scope of a SNF
  • Major Category II – Additional services excluded with rendered to specific beneficiaries
  • Major Category III – Additional excluded services rendered by certified providers
  • Major Category IV – Additional excluded preventive and screening services
  • Major Category V – Part B services included in SNF CB

From here, each category is further divided into several subsections, the changes to which are outlined below.

Major Category I. B. – Cardiac Catheterization

Add – C9741 Right heart catheterization with implantation of wireless pressure sensor in the pulmonary artery, including any type of measurement, angiography, imaging supervision, interpretation, and report (effective Jan. 1, 2016)

 

Major Category II. A. – (Dialysis) Coding Applicable to EPO and Aranesp Services

Add – J0604 Cinacalcet, oral, 1 mg, (for ESRD on dialysis)

Add – J0606 Injection, etelcalcetide, 0.1 mg

 

Major Category III. A. – Chemotherapy

Add – J9022 Injection, atezolizumab, 10 mg

Add – J9023 Injection, avelumab, 10 mg

Add – J9203 Injection, gemtuzumab ozogamicin, 0.1 mg

Add – J9285 Injection, olaratumab, 10 mg

Remove – J9300

 

Major Category III. C. – Radioisotopes and their Administration

Add – A9606 Radium ra-223 dichloride, therapeutic, per microcurie (effective Jan. 1, 2016)

Add – 77770 (effective Jan. 1, 2016)

Add – 77771 (effective Jan. 1, 2016)

Add – 77772 (effective Jan. 1, 2016)

Remove – 77785, 77786, 77787 (effective Dec. 31, 2015)

 

All coders who work with skilled nursing facilities should be sure to review these new codes and incorporate them accordingly throughout the year.