Cardiovascular Disease Services
Presented by Noridian Part B Medicare
Provider Outreach and Education
2016
DISCLAIMER
This information release is the property of Noridian Healthcare Solutions, LLC. It may be
freely distributed in its entirety but may not be modified, sold for profit or used in
commercial documents.
The information is provided “as is” without any expressed or implied warranty. While all
information in this document is believed to be correct at the time of writing, this
document is for educational purposes only and does not purport to provide legal advice.
All models, methodologies and guidelines are undergoing continuous improvement and
modification by Noridian and CMS. The most current edition of the information
contained in this release can be found on the Noridian website at
http://www.noridianmedicare.com and the CMS website at http://www.cms.gov
The identification of an organization or product in this information does not imply any
form of endorsement.
CPT codes, descriptors, and other data only are copyright 2016 American Medical
Association. All rights reserved. Applicable FARS/DFARS apply.
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Agenda
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•
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Medicare coverage information
Documentation
Coding and Diagnosis
Billing Requirements
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Objective
• Learn the coverage guides for screening
services
• Help understand the billing requirements
for each service
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Cardiovascular Disease
Screening Test
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Cardiovascular Disease
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Hypertension
Coronary Heart Disease
Heart Failure
Strokes
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Cardiovascular Disease
• Risk Factor
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Being overweight
Obesity
Physical inactivity
Diabetes
Cigarette smoking
High blood pressure
High blood cholesterol
Family history of myocardial infarction
Older age
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Screening Blood Tests
• Total Cholesterol Test
• Cholesterol Test for High Density
Lipoproteins (HDL)
• Triglycerides Test
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Frequency Limits
• 5 year period
– 59 months must elapse following the month
the month in which the last cardiovascular
disease screening blood test took place
– Regardless whether it is provided in a panel
or individually
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Qualified Ordering Providers
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Physicians
Clinical Nurse Specialist
Nurse Practitioner
Physician Assistant
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Coinsurance and Deductible
• Beneficiary pays nothing
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Documentation
• Ordered by a physician or qualified nonphysician practitioner
• Asymptomatic beneficiary
• For early detection of cardiovascular
disease
• Must fast for 12 hours
• Supporting CPT and ICD-10 codes shown
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Code and Diagnosis Information
• 80061 Lipid Panel
– Cholesterol, serum, total (82465)
– Lipoprotein, direct measurement, HDL (83718)
– Triglycerides (84478)
• 82465 Cholesterol, serum or whole blood,
total
• 83718 Lipoprotein, direct measurement,
(HDL cholesterol)
• 84478 Triglycerides
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Diagnosis Code
• ICD-10
– Z13.6 Encounter for screening for
cardiovascular disorder
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Intensive Behavioral Therapy
For Cardiovascular Disease
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Intensive Behavioral Therapy (IBT)
• Risk reduction visit
• Annually
– At least 11 months after most recent IBT
session
– Stand alone billable service
– May be obtained anytime after Medicare
enrollment, subject to frequency limitations.
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Intensive Behavioral Therapy (IBT)
• Three components
– Encouraging aspirin for primary prevention
• Men aged 45 to 79 years
• Women aged 55 to 79 years
– Screening for high blood pressure
• Adults aged 18 and older
– Intensive behavioral counseling
• Promote healthy diet
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Intensive Behavioral Therapy (IBT)
• Behavioral Counseling
– Assess
• Ask about/access behavioral health risk
– Advise
• Give clear, specific and personalized behavior
change advice
– Agree
• Select appropriate treatment goals
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Intensive Behavioral Therapy (IBT)
• Behavioral Counseling
– Assist
• Aid beneficiary in achieving agreed upon goals
– Arrange
• Schedule follow-up contacts for ongoing
assistance and support
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Primary Care Settings
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Office
Outpatient hospital
Independent clinic
Rural health clinic
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Coinsurance and Deductible
• The beneficiary pays nothing!
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Code and Diagnosis Information
• G0446
– Intensive behavioral therapy to reduce
cardiovascular disease risk, individual, face-toface, 15 minutes
• Diagnosis
– No specific ICD-10 code
– https://www.cms.gov/Medicare/Coverage/Covera
geGenInfo/ICD10.html
• Payment
– Based on MPFS
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Resources
• Medicare Claim Processing Manual
– http://www.cms.gov/Regulations-andGuidance/GuidanceManuals/Downloads/clm104c
18.pdf
• Medicare Learning Network article MM7636
– http://www.cms.gov/Outreach-andEducation/Medicare-Learning-NetworkMLN/MLNMattersArticles/Downloads/MM7636.
pdf
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Part B Webinars
Date
1/13/16
1/13/16
1/14/16
Time (CT)
Webinar Title
11:00 AM Screening Services
PDT
1:00 PM PDT Preventive Services
1:00 PM PDT Podiatry Services
Register Now!
JE https://med.noridianmedicare.com/web/jeb/education/training-events
JF https://www.noridianmedicare.com/partb/train/workshops/index.html
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CEU Process Reminder
• When registering, add additional attendees
– First and last names
• Attend entire workshop
– Q/A attendance optional
• Take short polling survey
– After closing out of webinar
• CEU emailed 3 days after presentation
– Earn between .5 and 1.5 CEUs
– No password or index number needed
– All providers may use CEU certificate
• Certificate of Attendance no longer available
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Questions?
Thank you!