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Clarification on Transmittal 881
Transmittal 881, Change Request 5252, dated March 3, 2006 addresses Hospital Emergency Room Services Exceeding 24 Hours. The Transmittal states that hospital OPPS claims for emergency room services exceeding 24 hours should be billed:
- with the emergency room identified with revenue code 450,
- with the date of service listed as the date the service was provided in the ER,
- with 1 date of service, the date the patient entered the emergency room, and
- service units equal to 1.
Further clarification from CMS indicated that the hospital should report the actual visit to the ER with revenue code 45x and the appropriate HCPCS code with the date the patient entered the ER. All remaining services received as a result of the ER visit should be reported with the appropriate revenue code and HCPCS code using the date the services were actually rendered.
April 2006 Edits for Drug Administration
As all hospitals are aware by now, Version 12.0 of the Correct Coding Initiative (CCI) edits were implemented for drug administration services paid under the OPPS furnished on or after April 1, 2006. There has been particular concern about the impact of the CCI edits when the following code pairs are reported on the same claim for the same service. These code pairs are:
| Column 1 |
Column 2 |
| C8950 |
C8952 |
| C8953 |
C8950 |
| C8953 |
C8952 |
| C8954 |
C8950 |
| C8954 |
C8952 |
| C8954 |
C8953 |
This issue has been brought to the attention of CMS by several hospitals. CMS has stated that they are currently working to resolve concerns that have been raised by numerous hospitals about the impact of CCI edits on reporting these code pairs. CMS will announce on the CMS website, through the hospital listserve, the steps it is taking to address the issues raised by hospitals in connection with these particular CCI edits.
New Admission Source Code D
On April 3, a new source of admission code, “D”, was introduced. Source of admission code D is used to define transfers from hospital inpatients in the same facility resulting in a separate claim to the payers. This code is to be used for transfers involving:
- distinct part units in an acute care hospital,
- a unit in a critical access hospital, or
- a swing bed located in an acute care hospital.
The following table describes source of admission codes “4” and “D”:
| Source of Admission Code |
Descriptor |
| 4 |
Transfer from a hospital (different facility)
Inpatient: The patient was admitted to this facility as a hospital transfer from a different acute care facility where he/she was an
inpatient.
Outpatient: The patient was referred to this facility for outpatient or referenced diagnostic services by (a physician of) a different acute care facility. |
| D |
Transfer from hospital inpatient in the same facility resulting in a separate claim to the payer. |
Cardiac Rehabilitation Services
Effective March 22, 2006 Medicare has expanded coverage for cardiac rehabilitation programs to include 3 new covered indications and has extended the time frame for performing the services to include up to 36 sessions.
The 3 newly covered indications are: 1) heart valve repair/replacement; 2) percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting; and 3) heart or heart-lung transplant.
The updated policy also now allows up to 18 weeks for a beneficiary to receive their maximum 36 cardiac rehabilitation services.
Additional services may be covered at the discretion of the Medicare contractor, but may not exceed 72 sessions within a 36 week period.
The updated policy also clarifies language regarding physician supervision and facility requirements and the physician’s physical location during the rehabilitation services. Specifically the NCD requires that:
- The program must be staffed by personnel necessary to conduct the program safely and effectively, who are trained in both basic and advanced life support techniques and in exercise therapy for coronary disease; and
- The facility must have available for immediate use the necessary cardiopulmonary, emergency, diagnostic, and therapeutic life-saving equipment accepted by the medical community as medically necessary, e.g., oxygen, cardiopulmonary resuscitation equipment, or defibrillator.
The Medicare Claims Processing Manual instructs that:
- Cardiac rehabilitation programs shall be performed incident to physician’s services in outpatient hospitals, or outpatient settings such as clinics or offices.
Be sure to pass this information on to the cardiac rehab staff. Remind them to review the local coverage determination for cardiac rehabilitation also.
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