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April 2008 OPPS Update
This newsletter will summarize the April 2008 Update to the
Hospital OPPS System as published on the CMS website in Change Request 5999
which was effective April 1, 2008, implemented April 7, 2008.
1. CMS deleted the procedure/device edit for CPT code 36815
(insertion of cannula for hemodialysis, arteriovenous, external revision or
closure).
2. Hospitals are strongly encouraged to report charges for all
drugs, biologicals and radiopharmaceuticals whether they are packaged or paid
separately. The correct HCPCS code should be used and the quantity of units of
service should correspond to that given to the patient according to the dosage
listed in the HCPCS Level II Book.
3. Four drugs have been granted pass-through status, effective
April 1, 2008:
CPT/
HCPCS |
Long Descriptor |
SI |
APC |
| C9241 |
Injection, doripenem, 10 mg |
G |
9241 |
| C9240 |
Injection, ixabepilone, 1 mg |
G |
9240 |
| C9238 |
Injection, levetiracetam, 10mg |
G |
9238 |
| J9226 |
Histrelin implant (Supprelin La), 50 mg |
G |
1142 |
4. Three new HCPCS codes for drugs and biologicals have been
created as of
April 1, 2008:
CPT/
HCPCS |
Long Descriptor |
SI |
APC |
| Q4096 |
Injection, Von Willebrand factor complex, human, ristocetin cofactor (not
otherwise specified), per i.u. VWF:RCO |
K |
1213 |
| Q4097 |
Injection, immune globulin (Privigen), intravenous, non-lyophilized (e.g.,
liquid), 500 mg |
K |
1214 |
| Q4098 |
Injection, iron dextran, 50 mg |
K |
1215 |
5. CMS has revised the short and long descriptors for C8921-C8928,
Cardiac Echocardiography Services, to appropriately reflect services that use
contrast or are performed without contrast followed by contrast. See the chart
below. The appropriate units of the HCPCS Q codes for the contrast agents
should be reported separately.
Echocardiograms without contrast should be reported with the appropriate CPT
codes, 93303-93350.
| HCPCS |
Revised Short
Descriptor |
Revised Long Descriptor |
| C8921 |
TTE w or w/o fol w/cont, com |
Transthoracic echocardiography with contrast, or without contrast followed by
with contrast, for congenital cardiac anomalies, complete |
| C8922 |
TTE w or w/o fol w/cont, f/u |
Transthoracic echocardiography with contrast, or without contrast followed by
with contrast; follow up or limited study |
| C8923 |
2D TTE w or w/o fol w/con, co |
Transthoracic echocardiography with contrast, or without contrast followed by
with contrast, real-time with image documentation (2d) with or without m-mode
recording; complete |
| C8924 |
2D TTE w or w/o fol w/con, fu |
Transthoracic echocardiography with contrast, or without contrast followed by
with contrast, material real-time with image documentation (2d) with or without
m-mode recording; follow up or limited study |
| C8925 |
2D TTE w or w/o fol w/con, in |
Transesophageal echocardiography (tee) with contrast, or without contrast
followed by with contrast, material real-time with image documentation (2d)
(with or without m-mode recording); including probe placement, image
acquisition, interpretation and report |
| C8926 |
TEE w or w/o fol w/cont, cong |
Transesophageal echocardiography (tee) with contrast, or without contrast
followed by with contrast, for congenital cardiac anomalies; including probe
placement, image acquisition, interpretation and report |
| C8927 |
TEE w or w/o fol w/cont, mon |
Transesophageal echocardiography (tee) with contrast, or without contrast
followed by with contrast, for monitoring purposes, including probe placement,
real time 2-dimensional image acquisition and interpretation leading to ongoing
(continuous) assessment of (dynamically changing) cardiac pumping function and
to therapeutic measures on an immediate time basis |
| C8928 |
TEE w or w/o fol w/cont, stress |
Transthoracic echocardiography with contrast, or without contrast followed by
with contrast, real time with image documentation (2d), with or without m-mode
recording, during rest and cardiovascular stress test using treadmill, bicycle
exercise and/or pharmacologically induced stress, with interpretation and
report |
6. Use of Modifier -FC. The Medicare Claims Processing Manual was
updated to require that hospitals report modifier -FC (partial credit received
for replaced device) for cases in which the hospital receives a partial credit
of 50% or more of the cost of a new replacement device under warranty, recall
or field action. Modifier -FC should be appended to the procedure code rather
than the device code.
7. Billing and Payment for Blood and Blood Products. The Claims
Processing Manual was updated with clarification regarding billing for blood
and blood products.
"CMS specifies that the requirement that the same line item date of
service, the same number of units, the same HCPCS code, and HCPCS modifier BL
must be reported on both lines for all OPPS providers that
transfuse blood. CMS also clarifies that, in order to ensure correct
application of the Medicare blood deductible, providers should report charges
for whole units of packed red cells using Revenue Code 381 (packed red cells),
and should report charges for whole units of whole blood using Revenue Code 382
(whole blood). Revenue Code 381 and 382 should be used only to report charges
for packed red cells and whole blood respectively. Revenue Code 388 is not a
valid revenue code for Medicare billing.
It further clarifies that providers should bill split units of
packaged red cells and whole blood using Revenue Code 389 (other blood), and
should not use Revenue Codes 381 (packed red cells) or 382 (whole blood).
Providers should bill split units of other blood products using the applicable
revenue codes for the blood product type, such as 383 (plasma) or 384
(platelets), rather than 389.
Where blood or a blood product is split or irradiated specifically
with the intent of transfusion to a beneficiary but is not then used, the
hospital may bill for the services of splitting or irradiating the unit of
blood but may not bill for the HCPCS code for the blood product that was not
transfused. The date of service must be the date on which the decision not to
use the blood was made and indicated in the patient's medical record. Where the
unit of blood is split or irradiated and stored without specific intention to
administer it to a Medicare beneficiary at the time of splitting or irradiation
and is not subsequently transfused, there is no service to be reported."
8. Coverage Determinations, Reminder! The fact that a drug, device,
procedure or service is assigned a HCPCS code and a payment rate is listed does
not imply coverage by the Medicare program, but only indicates how the service
may be paid if covered by the Medicare program.
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