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Issue 7, Vol. 3
September 2005

Partners in
Healthcare
Improvement

Charlene Nutter
Senior Consultant
(614) 227-4852
cnutt@qmcg.com

The Quality Management
Consulting Group, Ltd.
100 S. Third St.
Columbus, OH 43215
Ph: (614) 227-4848
Fx: (614) 227-2390
Email: info@qmcg.com

UPDATE TO OPPS

Transmittal 662 published the October 2005 Update of OPPS on August 26, 2005. Highlights of the Transmittal include:

• The FISS system will not accept a zero charge so when reporting a device when the hospital incurs no cost, the hospital should submit a token charge (i.e., $1.00) on the line with the device code.
• Two new drugs have been designated as eligible for pass-through status effective October 1, 2005. They are:

HCPCS	APC	SI	Long Descriptor
C9225	9225	G	Injection, fluocinolone acetonide intravitreal implant, per 0.59 mg
C9226	9226	G	Injection, ziconotide for intrathecal infusion, per 5 mcg

• The following new service is assigned payment under OPPS:

HCPCS	Effective Date	SI	APC	Short Descriptor	Long Descriptor
C9725	10/01/05	S	1507	Place endorectal app	Placement of endorectal intracavity applicator for high intensity brachytherapy

• One new code can be reported for payment as a brachytherapy source:

HCPCS	Effective Date	SI	APC	Short Descriptor	Long Descriptor
C2637	10/01/05	H	2637	Brachytx, Ytterbium-169	Brachytherapy source, Ytterbium-169, per source

• Effective October 1, 2005 CMS is expanding the device edits to apply more procedure codes for which a device is essential to performing the procedure. In some cases there are some HCPCS codes for procedures that require a device but for which there are no device edits. This was not an oversight. In some cases the device codes that exist do not describe all possible devices that could be used in the procedure, so a claim could be returned to the provider that properly coded the procedure but omitted the device because there was not an appropriate code for the device code. In other cases the procedure is not on the list of procedures that have received adjusted payment and, therefore, no device editing is being implemented now.

Related to this issue, MedLearn Matters Number MM4017 states that device edits do not apply to the specified procedure code if the provider reports one of the following modifiers with the procedure code:

-52 reduced services
-73 discontinued outpatient procedure prior to anesthesia
-74 discontinued outpatient procedure after anesthesia administration

When a procedure that normally requires a device is interrupted and the device is not used, then the procedure should be listed on the claim with modifier -52, -73, or -74.

BILLING ALERT ISSUED

AdminaStar Federal (F.I. for Ohio, Kentucky, Indiana and Illinois) recently posted a Billing Alert on their website regarding device codes/edits. According to the article, there has been an increase in claims submission error W7071 (the reason code assigned to claims that contain a procedure code for inserting a device when no device code was listed on the claim).

Hospitals should be reminded that effective for services after 4/1/05 all hospitals paid under OPPS must report a code for a device when reporting certain procedure codes identified by CMS.

ICD-9-CM CHANGES, OCTOBER 1

Don’t forget all ICD-9-CM diagnosis and procedure code changes are effective October 1st!