May 1999 Newsletter
AST Testifies Before the House
of Representatives Regarding Organ Supply Issues
On Thursday, April
15, 1999, Representative Michael Bilirakis (R-FL), Chairman
of the House Commerce Subcommittee
on Health, convened a hearing entitled, "Putting Patients
First: Increasing Organ Supply for Transplantation." As
stated by the Subcommittee, the purpose of the hearing was
to allow Members of Congress, "to learn more about the
problems of organ shortages and the solutions being considered
in state and federal programs as the Commerce Subcommittee
on Health considers reauthorizing the National Organ Transplant
Act (NOTA)."
Although the hearing was limited
to only two panels of witnesses, Subcommittee Chairman Michael
Bilirakis invited AST President John Neylan, MD, to testify
and discuss the views of the Society on these important issues.
AST's testimony focused on the importance of increasing education
and improved coordination among the public and private sectors
to improve donation rates. In addition, Dr. Neylan also discussed
specific legislative initiatives endorsed by AST, such as Congressman
Elijah Cummings (D-MD) legislation, which seeks to increase
the amount of leave time available to Federal employees serving
as donors. AST also stressed the importance of adequate federal
support for organ donation initiatives and applauded such programs
as the Department of Health and Human Services' National Donor
Recognition Ceremony.
The Society's testimony was very
well received by members of the Subcommittee. Following the
hearing, Chairman Bilirakis and his Majority Counsel Staff
applauded the efforts of AST and indicated that they look forward
to working closely with the Society as transplantation public
policy issues continue to evolve.
Note: AST's testimony before
the House Commerce Subcommittee on Health can be accessed
on the public policy section of the Society's website. (http://www.a-s-t.org/pubpol.htm).
AST Asks Congress
to Increase FY 2000 Funding for Transplant Research
On Thursday, April
15, 1999, AST President John Neylan, MD, traveled to Capitol
Hill to testify
in support of a 15 percent increase for the National Institutes
of Health and to expand research in the area of transplantation.
Testifying before the House Appropriations Subcommittee Chairman
John Porter (R-IL), Dr. Neylan, discussed the status of transplant
research and new opportunities to expand such research at the
National Institute for Allergy and Infectious Diseases (NIAID);
National Institute for Diabetes, Digestive, and Kidney Disease
(NIDDK); and the National Heart, Lung, and Blood Institute
(NHLBI). AST's testimony also discussed and stressed the importance
of continued support and funding for national organ and tissue
donation initiatives within the Division of Transplantation
at the Health Resources and Services Administration. Dr. Neylan
asked the House panel to continue its leadership and strong
support of biomedical research and requested a 15 percent increase
in funding for NIH as the second installment toward doubling
the NIH budget by FY 2003. During his testimony, Dr. Neylan
stated to the House Appropriations Subcommittee, "To truly
translate the promise of scientific discovery into better health
for all Americans - the President, Congress, and the American
people must continue the commitment to significant, sustained
growth in funding for the NIH.
Following AST's testimony, Chairman
John Porter commended Dr. Neylan and the Society for its leadership
in moving the field of transplantation forward. Chairman Porter
stated that he is very supportive of biomedical research in
the field of transplantation and would do everything that he
can to support new research and advances in the field.
AST's testimony before the House
Commerce Subcommittee on Health can be accessed on the public
policy section of the Society's website (http://www.a-s-t.org/pubpol.htm).
AST Represents
Transplant Physicians at HHS National Donor Recognition
Ceremony
On Sunday, April
18, 1999, AST President, John Neylan, MD, joined Surgeon General
David Satcher, MD,
to recognize individuals who have given the ultimate gift……..the
gift-of-life. Each year the Department of Health and Human
Services (HHS) and the Health Resources and Services Administration
(HRSA) convene a National Donor Recognition Ceremony to celebrate
and recognize our nation's organ donors. At the request of
HHS, Dr. Neylan, joined Surgeon General Satcher in providing
opening remarks to a large audience of organ donors from across
the country. During his remarks, Dr. Neylan commended those
individuals who have given the gift-of-life and further challenged
the transplant community, broadly defined, to continue to improve
education and cooperation activities to increase organ donation.
Dr. Neylan also discussed a recent federal report announcing
that the number of organ donors increased by 5.6 percent in
1998 (the first substantial increase since 1995). With regard
to federal initiatives and improvements to the current organ
donation system, Dr. Neylan discussed the recent federal regulation
requiring hospitals to notify their local organ procurement
organization of deaths as a condition of participation (COP)
within the Medicare Program. Dr. Neylan also discussed AST's
support of legislative initiatives aimed at improving organ
donation - such as Congressman Elijah Cummings (D-MD) bill,
H.R. 457, which seeks to increase the amount of leave time
available to federal employees serving as donors.
Visit the AST
Annual Meeting Public Policy/Government Affairs Booth
As you may be aware,
AST has been very active and successful in the public policy
arena, on Capitol
Hill and within the Administration, on a variety of important
national policy issues impacting the field of organ transplantation.
During the Society's Annual Meeting in Chicago, AST's Washington
Representative team will be on hand in the “Public Policy Booth” to
discuss and showcase the Society's government affairs accomplishments
and activities. Please take a moment to stop by the AST Public
Policy Booth to meet the Society's Washington Representatives.
In addition to providing information
regarding the Society's leadership role in transplant public
policy, the AST Public Policy Booth will also be providing
free business card/luggage tags with the Public Policy website
and contact information attached.
Stop by the booth and learn more
about how you can contribute to the success of AST's Public
Policy program!!
Learn
How AST Advocates Important Public Policy Views to Key
Decision-Makers
in Our Nation's Capitol—Attend the AST Annual Meeting Public
Policy Luncheon
On Tuesday, May
18, 1999, the AST Public Policy Committee and staff will sponsor
a lunch (12:30pm
to 2:00pm) on the "How-To" of public policy advocacy
activities. The luncheon briefing will focus on how AST has
supported and successfully moved forward a variety of important
public policy issues within Congress and the Administration.
Guest speakers include AST Public Policy member, William Harmon,
MD, Senior Legislative Staff from the Office of Congressman
John Porter (R-IL), Chair of the House Appropriations Subcommittee
on Labor, Health and Human Services, and AST's Public Policy
representatives from Washington, D.C. Check your registration
packets and sign-up today! Space is limited!
AST Leaders Selected
to Serve As Expert Panelists to IOM on Organ Procurement
and Transplantation Study
AST President, John Neylan, MD,
and Public Policy Committee member, William Harmon, MD, have
been selected by the Institute of Medicine (IOM) to serve on
the Expert Panel advisory group for transplantation. At present,
the IOM is in the process of examining technical and policy
issues surrounding the nation's current system for transplantation
and the HHS's proposed regulations seeking to amend that system.
As expert panelists, Dr. Neylan and Dr. Harmon will serve as
a resource to the IOM Study Committee on Organ Procurement
and Transplantation Policy. The IOM Committee is expected to
draft and issue a report on their findings in mid-July of 1999.
Federal Report
Shows Organ Donation Up 5% in '98
The Department of Health and Human
Services and the United Network for Organ Sharing (UNOS) recently
released figures showing organ donation increased by 5.6 percent
in 1998.
According to the report, donation
increases between 1997 and 1998 were substantial for Caucasians
(up 6.6 percent from 4,139 to 4,410 donors) and Hispanics (up
7.8 percent from 552 to 595 donors). The number of African-American
donors remained relatively unchanged at 654 donors in 1998,
and the number of Asian donors decreased by 8.4 percent from
107 to 98 donors.
With regard to age, donors increased
for all age ranges; but the largest increase was in donors
age 60 and above (up 10.8 percent from 706 to 782). Donors
age 40 to 59 increased by 9.6 percent (1,781 to 1,952). Donors
age 20 to 39 increased by 2.4 percent (1,653 to 1,693) and
age 0 to 19 increased only slightly by 1.6 percent (1,339 to
1,361).
Regionally, the largest increase
in donations occurred in the central region of the United States.
UNOS Region 10 (Michigan, Indiana and Ohio) had the largest
increase at 13 percent (from 500 to 565). UNOS Region 8 (Iowa,
Missouri, Nebraska, Kansas, Wyoming and Colorado) increased
by 11.3 percent (from 380 to 423), and Region 4 (Oklahoma and
Texas) increased by 9.1 percent (from 472 to 515).
New HCFA Claims Processing
Instructions for Pancreas Transplantation
PROGRAM MEMORANDUM INTERMEDIARIES
Department of Health and Human Services
Health Care Financing Administration
Transmittal No. A-99-16 Date April
1999
CHANGE REQUEST 844
SUBJECT: New HCFA Claims Processing
Instructions for Pancreas Transplantation
This Program Memorandum contains
billing instructions for contractor use in processing claims
for pancreas transplantation. Effective for dates of service
on or after July 1, 1999, Medicare will cover pancreas transplantation
when it is performed simultaneously with or after a Medicare
covered kidney transplant (ICD-9-CM procedure code 55.69; HCPCS
codes 50360, 50365).
Background
Pancreas transplantation is performed to induce an insulin independent, euglycemic
state in diabetic patients. The procedure is generally limited to those
patients with severe secondary complications of diabetes including kidney
failure. However, pancreas transplantation is sometimes performed on
patients with labile diabetes and hypoglycemic unawareness.
Medicare has had a policy of not
covering pancreas transplantation. The Office of Health Technology
Assessment performed an assessment on pancreas-kidney transplantation
in 1994. They found reasonable graft survival outcomes for
patients receiving either simultaneous pancreas-kidney (SPK)
transplantation or pancreas after kidney (PAK) transplantation
Claims Processing Changes and
Intermediary Instructions
There are no special provisions related to managed care participants. Managed
care plans are required to provide all Medicare covered services. Medicare
does not restrict which hospitals or physicians may perform pancreas transplantation.
Hospital Billing Instructions
- • Revenue Codes/ICD-9-CM
Procedure Codes
• Revenue Code-360 Operating Room Services
• Revenue Code-81X Organ Acquisition (X=1-4)
Acquisition cost will be in this
revenue center for pancreas and kidney transplants. Override
any claims suspended due to repetition of revenue code 81X
on the same claim. Pay for acquisition costs for both kidney
and pancreas organs. Do not pay for more than two organ acquisitions
on a single claim.
The transplant procedure and revenue
code for the operating room are paid under these codes. Procedures
must be reported using the current ICD-9-CM procedure codes
for pancreas and kidney transplants. Providers must place at
least one of the following transplant procedure codes on the
claim:
-
- 52.80 Transplant of pancreas
52.83 Heterotransplant of pancreas
HCFA Pub. 60A
- * HCPCS Codes
The following HCPCS code is to be
used for pancreas transplantation:
- • 48554-Transplantation
of pancreatic allograft. •
*Conditions of Coverage/ICD-9-CM Diagnosis Codes
One or more of the following ICD-9-CM diagnosis codes must be present:
- • 250.0
0 Diabetes mellitus without mention of complication,
type II (non-insulin
dependent) (NIDDM) (adult onset) or unspecified type,
not stated as uncontrolled.
• 250.0 1 Diabetes mellitus without mention of complication, type I (insulin
dependent) (IDDM) (juvenile), not stated as uncontrolled.
• 250.0 2 Diabetes mellitus without mention of complication, type II (non-insulin
dependent) (NIDDM) (adult onset) or unspecified type, uncontrolled.
• 250.0 3 Diabetes mellitus without mention of complication, type I (insulin
dependent) (IDDM) (juvenile), uncontrolled.
NOTE: X=0-3
- • 250.1X
Diabetes with ketoacidosis
• 250.2X Diabetes with hyperosmolarity
• 250.3X Diabetes with coma
• 250.4X Diabetes with renal manifestations
• 250.5X Diabetes with ophthalmic manifestations
• 250.6X Diabetes with neurological manifestations
• 250.7X Diabetes with peripheral circulatory disorders
• 250.8X Diabetes with other specified manifestations
• 250.9X Diabetes with unspecified complication
Also include ICD-9-CM diagnosis
code 585, Chronic renal failure, unless one of the following
codes is present:
- • V42.0
Organ or tissue replaced by transplant kidney
• V43.89 Organ tissue replaced by other means, kidney or pancreas
NOTE: If the pancreas transplant
occurs after the kidney transplant, the 36-month period of
entitlement to immunosuppressive therapy will begin with
the date of discharge from the stay for pancreas transplant.
NOTE: The Common Working File
will edit to ensure that a claim for kidney transplant (ICD-9-
CM code 55.69) has been received prior to pancreas transplantation.
Medicare Summary Notice (MSN) and
Explanation of Your Medicare Benefits (EOMB)/Remittance Messages
If a claim for simultaneous pancreas
kidney transplantation or pancreas transplantation following
a kidney transplant is submitted to you and is missing one
of the appropriate diagnosis/procedure codes, deny the claim
and use the following EOMB notice or MSN:
- • EOMB 16.79, “Medicare
does not pay separately for this service. You do not have
to pay
this amount.”
• MSN 16.32, “Medicare does not pay separately for this service.” Use the following
in the Remittance Message(s):
• Claim adjustment reason code B15, “Claim/service denied/reduced because this
procedure/service is not paid separately. The zero dollar amount of payment for
this will signify denial rather than reduction.”
To further clarify
the situation, when B15 is used for this type of denial, the
intermediary
should also use new claim level remark code MA 126, “Pancreas
transplant not covered unless kidney transplant performed.”
