With more specific codes available for Parkinson’s and COPD, one Medicare Administrative Contractor is shifting the codes it’s using for Targeted Probe & Educate (TPE) reviews.
On Jan. 26, CGS updated its list of codes included in TPE pre-payment and post-payment review for medical necessity. They note that targeted codes were updated effective Oct. 1, 2023.
The list now includes a shift from G20 (Parkinson’s disease) to the newly expanded codes: G20.A1 (Parkinson’s disease with dementia), G20.A2 (Parkinson’s disease with mild cognitive impairment), G20.B1 (Parkinson’s disease with psychosis), G20.B2 (Parkinson’s disease with depression) and G20.C (Parkinson’s disease with autonomic dysfunction).
These expanded codes capture the comorbidities and complications of Parkinson’s disease, notes Brian Lebanion, health care consulting manager for Wipfli in Irvine, Calif.
“This required the TPE audit criteria to be updated as the old code G20 would no longer be used,” he says. “It’s important to note that physician documentation will need to be scrutinized to ensure the appropriate code is selected as coding guidelines must always be adhered to and coding the highest specificity is required.”
The other change was a move from J44.1 (COPD) to more specific codes under J4A (chronic lung allograft dysfunction). This change indicates CMS is targeted more specific diseases related to complications of kidney transplantation, Lebanion says.
This should result in less claims being selected, he says, as J44.1 is used more frequently than the more specific J4A series.
“Providers should be sure to pay attention to coding guidelines and select the most appropriate diagnosis codes that can be supported in the clinical record,” he says.
The full list under review are home health claims with 2 to 6 visits and diagnosis code I11.0, Z46.6, J4A.0, J4A.8, J4A.9, I10, J44.9, G20.A1, G20.A2, G20.B1, G20.B2, G20.C, I25.10, N39.0, J18.9 or I87.2.