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Tag Archives: Adds

CMS Adds 11 Codes to Telehealth List

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Physicians can now offer more services via telehealth and get paid. The Centers for Medicare & Medicaid Services (CMS) is adding 11 codes to the list of telehealth services payable under the Medicare Physician Fee Schedule (MPFS). Coverage is retroactive to March 1, 2020, and is effective for the duration of the public health emergency […]

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ICD-10-PCS 2021 Adds 544 New Codes

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The 2021 ICD-10-PCS files are now available. Inpatient coders will have 544 new codes to work with beginning Oct. 1, 2020, as well as changes to tables and the index. New PCS Codes Additions include several codes for: Insertion of radioactive element into various body sites, by various approaches Fragmentation of various veins and arteries […]

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Tip: CMS adds payment for advance care planning in certain scenarios

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CMS changed the status indicator for CPT code 99497 (advance care planning including the explanation and discussion of advance directives such as standard forms [with completion of such forms, when performed], by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member, and/or surrogate) from N (no additional payment, payment included in line items with APCs for incidental service) to Q1 in the 2016 OPPS final rule.

This means that separate payment will be provided when this service is provided on a date of service without a visit (status indicator V) or procedure (status indicator S or T).
 
Add-on code 99498 (advance care planning; each additional 30 minutes), like most other add-on codes under the OPPS, is unconditionally packaged and assigned status indicator N.
 
This tip is adapted from “CMS shifts 2-midnight rule responsibility to QIOs, finalizes packaging expansion” in the January issue of Briefings on APCs.

HCPro.com – APCs Insider

Civica Rx Adds 250 Hospitals, Plans 14 Drugs

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Civica Rx announced that 12 new health systems representing 250 hospitals nationwide, have joined the not-for-profit generic drug company as founding members. That brings the number of hospitals that have joined the project designed to make generic drugs more accessible and less expensive to 750. Civica Rx to Solve Supply, Cost Problems Spotty supply and […]

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CMS adds new comprehensive APCs in 2016 OPPS final rule

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The 2016 OPPS final rule includes the first negative payment update for the system, but CMS also listened to commenters on a variety of proposals to make them less onerous either operationally or financially.
 
“CMS’ language is quite firm in parts of the rule when explaining why some proposals were finalized, but the agency also showed its willingness to listen to providers who submitted detailed comments for other proposals,” says Jugna Shah, MPH, president and founder of Nimitt Consulting, based in Washington, D.C., and Spicer, Minnesota.
 
CMS adds 10 C-APCs
CMS did not change the logic for comprehensive APCs (C-APC) or complexity adjustments in the final rule, but did add 10 new C-APCs for 2016 in addition to the 25 established for the first time for 2015. This is up from the nine CMS proposed, due to the addition of a level 5 for musculoskeletal procedures.
 
CMS finalized C-APC 8011 (comprehensive observation services) to replace the existing extended assessment and management (EAM) composite APC 8009. Payment for C-APC 8011 will be made when a claim contains a specific combination of services performed with each other (similar to the existing EAM), instead of only using a primary service CPT® code assigned to status indicator J1 like other C-APCs. CMS will use status indicator J2, newly introduced for 2016, to identify these combinations of services for the observation C-APC.
 
Providers will need to meet all of the following criteria to qualify for C-APC 8011 payment in 2016:
  • Claims do not contain a procedure with status indicator T (significant procedure subject to multiple procedure discounting)
  • Claims do contain eight or more units of services described by HCPCS code G0378 (observation services, per hour)
  • Claims contain G0378 and any one of the following codes on the same date of service or one day prior:
    • HCPCS code G0379 (direct referral of patient for hospital observation care) on the same date of service as HCPCS code G0378
    • CPT codes 99281–99284 (ED visit for the E/M of a patient [Levels 1-4])
    • CPT code 99285 (ED visit for the E/M of a patient [Level 5]) or HCPCS code G0380 (type B ED visit [Level 1])
    • HCPCS code G0381–G0384 (type B ED visit [Levels 2–5])
    • CPT code 99291 (critical care, E/M of the critically ill or critically injured patient; first 30–74 minutes)
    • HCPCS code G0463 (hospital outpatient clinic visit for assessment and management of a patient)
  • Claims do not contain a J1 service
 
CMS originally proposed to only allow high-level ED visits to help generate the observation C-APC, similar to the current EAM composite APC. But this is one of the proposals that CMS agreed with commenters on and determined the observation C-APC should be expanded to include all visit levels, says Shah.
 
The 2016 national payment rate for C-APC 8011 is $ 2,174.14, and while this payment is significantly higher than the EAM composite APC payment received today, providers should keep in mind that no other services are paid separately under the C-APC logic, says Shah, whereas today other services can, and do, generate separate payment.
 
“Any analysis that is done on separately payable observation services must be done carefully,” she says.
CMS finalized C-APC 5881 (ancillary outpatient services when patient dies) to replace composite APC 0375, which has the same description. The single, comprehensive payment would be applied for all services reported on the same date and on the same claim as an inpatient-only procedure with modifier –CA (procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission).
 
As a result of new C-APCs that are not largely based on previous device-dependent APCs, CMS is expanding the list of add-on codes that are evaluated for a complexity adjustment to include all add-on codes that can be appropriately reported with a base code that describes a primary J1 service.
A list of all packaged CPT add-on codes evaluated for a complexity adjustment is included in Table 8 of the final rule.
 
The other new C-APCs are similar to those established in 2015, assigned to different levels of procedures within similar clinical families.
 
“Providers need let their payment review and denial staff know about the services related to these C-APCs,” says Valerie A. Rinkle, MPA, Medicare regulatory specialist for HCPro, a division of BLR, in Danvers, Massachusetts.
 
With previous bundling that led to certain line items no longer being paid separately, many providers had claims routed to staff as denials, she says. If the billing office is alerted to changes in payment policies, providers can mitigate such delays.

 

Editor’s note: The 2016 OPPS final rule was published in the November 13 issue of the Federal Register. This article was originally published in Briefings on APCs. Email your questions to editor Steven Andrews at [email protected].

 

HCPro.com – JustCoding News: Outpatient

OIG Adds Items to Web-based Work Plan

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Effective June 15, 2017, the Office of Inspector General (OIG) now updates its Work Plan website monthly. The OIG Work Plan sets forth various projects — including OIG audits and evaluations that are underway or planned — to be addressed during the fiscal year and beyond by OIG’s Office of Audit Services and Office of […]
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VA Adds New Appointment App to Telehealth Program

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Last  year 700,000 veterans made around 2 million telehealth appointments at Veterans Affairs (VA) hospitals an other facilities, the agency said.  To enhance access to care, the VA rolled out two new initiatives. Appointments  at Hand In an event that included President Donald Trump and Veterans Affairs Secretary David Shulkin, MD, the VA debuted an […]
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CMS Adds Information for Administration Simplification

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The Centers for Medicare & Medicaid Services (CMS) unveiled a fact sheet to help understanding of HIPAA’s least-known provision, Administrative Simplification. The FAQ helps explain the three-pronged approach to simplification: electronic transactions, code sets, and unique identifiers. CMS said the fact sheet explains how Administrative Simplification standards streamline day-to-day tasks like: Billing Verifying patient eligibility Sending and receiving payment The […]
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