Reimbursement Questions for SnapshotNIR Answered by our Resident Expert, Moira Sykstus
ASK THE EXPERT Q&A
SnapshotNIR is now approved for Category III CPT codes. Find out what obtaining these new codes means for you and your medical practice as Kent’s Director of Reimbursement and Clinical Services, Moira Sykstus, answers all your questions on reimbursement.
Q: What is a Category III CPT code?
A: The American Medical Association assigns Category III CPT codes for new and emerging technologies, services, and procedures. These codes are effective for a period of no longer than five years and are assigned to allow providers and patients to utilize new technologies that have been shown to be clinically effective. During the time that the temporary codes are in place, the AMA expects that several things will occur in order to assign a permanent code:
Additional research will be completed in order to comply with the requirements of the Category I CPT code guidelines.
Providers utilize the technologies and submit claims with the Category III codes. This allows the AMA and CMS to determine if the new technologies are being adopted by providers. Utilization is essential to show that the new technology, service, or procedures are valuable to providers and are providing enhanced care to patients.
Q: When did the new CPT codes come into effect and what are the codes?
A: The new Category III CPT codes that apply to SnapshotNIR were effective July 1, 2021. They are 0640T, 0641T, and 0642T. Additional information on the codes, along with other reimbursement resources can be found on the Kent Imaging website at the following link: Kent Imaging Reimbursement
CMS published the MLN Matters® # MM12316 that also addresses the new codes. It can be found at CMS MLM MM12316.
Q: Should physicians continue to utilize the 0640T-0642T codes listed above as well as the APC Code 5732 for outpatient facilities?
A: The first rule of coding is to utilize the code(s) that most accurately reflect the services and/or procedures that were performed. Since the codes 0640T-0642T were created specifically for SnapshotNIR, they are the most appropriate codes to utilize by both providers and facilities.
Providers do not utilize APC codes. APC codes reference the “group” of codes that have been put together by category and reimbursed at the same base payment rates. They are utilized by Hospital Outpatient Departments, and typically only in the billing process. Most providers and clinical staff do not ever need to use them.
Providers will typically utilize 0640T if SnapshotNIR is utilized in an office, or in a freestanding clinic that is not considered to be a department of a hospital. Providers who are working in an HOPD (Hospital Outpatient Department) will typically utilize the 0642T for the professional interpretation of the results obtained from a SnapshotNIR study.
HOPDs will bill the 0641T, which is assigned to the 5732 APC group, to bill for the acquisition of SnapshotNIR image(s).
This question can become a bit complicated, especially in situations where services are performed in a Skilled Nursing Facility, Critical Access Hospital, or Ambulatory Surgery Center. Additional information can be found at: Kent Imaging Reimbursement
Q: What does obtaining these new codes mean for physicians? What is the importance of billing Category III codes?
A: The submission of claims to CMS, as well as other payers, with the new codes (0640T-0642T) is essential for two main reasons:
Providers are prohibited from providing free care to Medicare patients by the Federal Beneficiary Inducement Statute, as well as some additional State and Federal Anti-Kickback and Patient Inducement Laws. The National Correct Coding Initiative requires providers to submit claims utilizing the most accurate and appropriate codes for those services. Utilizing the new codes will assist providers and facilities to maintain compliant billing and coding practices.
Claim submissions utilizing the codes 0640T-0642T is the only way CMS and the AMA can track utilization of the SnapshotNIR technology. No matter how much research is completed, no matter how clinically relevant the technology or how beneficial it is to patients, the AMA and CMS will not assign a permanent CPT code or National Reimbursement policies for both providers and facilities unless they see that the technology is being adopted by providers and used regularly in clinical practice. The new codes must be used to show that SnapshotNIR is a technology that the medical community values.
Q: What needs to be captured in order to bill?
A: There are no National or Local Coverage Decisions that apply to our codes, so there are no documentation “requirements” outlined by CMS or any other payer. We recommend that providers and facilities document the use of SnapshotNIR just as they would any other diagnostic test or procedure:
What? SnapshotNIR
Why? What diagnosis, symptomology and/or clinical presentation is the provider noting that makes them think that the use of SnapshotNIR will be helpful or necessary?
Where? What location(s) is SnapshotNIR being performed?
Results? What were the results of the SnapshotNIR images?
Interpretation: What do the results mean or imply?
How? How will the results impact the plan of care? How will the provider use the information that was obtained from the interpretation of the results to evaluate the patients’ plan of care?
Additional information and guidelines can be found at the following link: Kent Imaging Reimbursement
Q: How do physicians, clinics, and hospital departments navigate the reimbursement process? Who can I contact?
A: There are several resources available to assist with the reimbursement process in addition to the resources already mentioned on the Kent Imaging Website.
Customers can contact their Sales Account Managers, who will assist them to determine what needs they have, and schedule training with the Reimbursement Team.
Customers may also call, toll-free, Kent’s Reimbursement Hotline at 1-833-SEE-KENT (1-833-733-5368)
Customers may submit questions to: reimbursement@kentimaging.com
Q: Can you explain why using “Unlisted” or “Miscellaneous” CPT codes for dates of service later than June 30, 2021 will no longer be appropriate to record?
A: The miscellaneous codes are not the most accurate (in other words, the most descriptive) codes available for the Snapshot device. The National Correct Coding Initiative requires that the most accurate and descriptive codes are used to submit claims for the services provided.
Q: Where can I get documentation guidelines?
A: A basic documentation guide, as well as other resources, can be found at Kent Imaging Reimbursement
Q: If I have further questions or want to direct a team member to more information, where do I go?
A: Individual questions and/or concerns can be addressed by the following methods mentioned above, through your Sales Account Manager, via our toll-free hotline, or email. Kent’s Reimbursement team will also assist with materials for submission to payers, and what may be necessary for insurance preauthorization documentation.
ADDITIONAL RESOURCES
In the latest ‘Advances in Skin and Wound Care Journal’, Kathleen Schaum, talks about reimbursement and covers even more important information on new CPT Category III Codes, exclusive to SnapshotNIR.