Thursday, February 17, 2022
- CMS Expands Coverage of Lung Cancer Screening with Low Dose Computed Tomography
- There’s Still Time to Recommend the Flu Shot
- Gap Billing Between Hospice Transfers
- April 2022 Update to the Medicare Severity – Diagnosis Related Group (MS-DRG) Grouper and Medicare Code Editor (MCE) Version 39.1 for the International Classification of Diseases, Tenth Revision (ICD-10) Diagnosis Codes for 2019 Novel Coronavirus (COVID-19) Vaccination Status and ICD-10 Procedure Coding System (PCS) Codes for Introduction or Infusion of Therapeutics and Vaccines for COVID-19 Treatment — Revised
CMS Expands Coverage of Lung Cancer Screening with Low Dose Computed Tomography
On February 10, CMS announced a national coverage determination that expands coverage for lung cancer screening with low dose computed tomography (LDCT) to improve health outcomes for people with lung cancer. This final decision expands eligibility for people with Medicare to get lung cancer screening with LCDT by:
- Lowering the starting age for screening from 55 to 50 years
- Reducing the tobacco smoking history from at least 30 packs per year to at least 20 packs per year
There’s Still Time to Recommend the Flu Shot
It’s not too late to recommend flu shots for your patients. Flu activity usually peaks in February but can continue into May.
Not only do people over 65 have a higher risk of flu complications, but some people with Medicare are less likely to get the flu shot than others. Black, American Indian/Alaska Native, and Hispanic patients continuously get the flu shot less often than White or Asian/Pacific Islander patients. Find out more about vaccination disparities (PDF), and help protect your patients by:
- Using each office visit to talk with your patients about why it’s important to get the flu shot
- Sharing handouts with patients who want additional information, have questions, or decline the flu shot
- Referring patients to a vaccine provider if your practice doesn’t give the flu shot
Medicare Part B covers 1 flu shot per flu season and additional flu shots if medically necessary. Your patients pay nothing if you accept assignment.
- CMS Flu Shot webpage
- CDC Seasonal Influenza Vaccination Resources for Health Professionals webpage
- CDC's Prepare Your Practice to Fight Flu presentation
- Flu Shots: information for your patients
Surgical Dressings: Medicare Requirements
Medicare covers primary or secondary surgical dressings:
- Used to protect or treat a wound
- If needed after debridement of a wound
The patient’s medical records should include clinical information to demonstrate reasonable and necessary need for the type and quantity of surgical dressings. Providers must evaluate the wound monthly and update the record, unless they document why they can't do a monthly evaluation and how they're monitoring the patient's ongoing use of dressings.
See the Surgical Dressings – Policy Article for more information.
MLN Matters® Articles
Gap Billing Between Hospice Transfers
Learn about system edits and Medicare Claims Processing Manual revisions to prevent gap billing (PDF):
- There can’t be a gap in the number of billing days between the transferring and receiving hospices
- The “from date” for the receiving hospice must be the same as the “through date” for the transferring hospice
- If the patient is transferring from outside the service area and the transferring hospice can’t arrange care until the patient reaches the receiving hospice, the transferring hospice may discharge the patient
- We'll reject the hospice transfer if it doesn’t occur immediately, based on the same “from” and “through” dates
April 2022 Update to the Medicare Severity – Diagnosis Related Group (MS-DRG) Grouper and Medicare Code Editor (MCE) Version 39.1 for the International Classification of Diseases, Tenth Revision (ICD-10) Diagnosis Codes for 2019 Novel Coronavirus (COVID-19) Vaccination Status and ICD-10 Procedure Coding System (PCS) Codes for Introduction or Infusion of Therapeutics and Vaccines for COVID-19 Treatment — Revised
Learn about 2 new ICD-10 procedure codes for COVID-19 monoclonal antibodies (PDF).
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