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Coding Corner: Are These OPPS Changes on Your Facility's Radar?

Make sure you're billing correctly for mammographies, observation

If you're receiving denials for services you've performed since Jan. 1, you may need a refresher course on this year's OPPS adjustments. Here's the essential info your facility needs to report observation, infusion and mammographies with ease.
1. Observation lightens up.

CMS realized its requirements for earning observation payment in facilities weren't generating adequate reporting - so the agency gave the rules a user-friendly makeover. For starters, the tests that were required for payment last year are no more. The physician will probably still give a congestive heart failure (CHF) patient a chest x-ray and pulse oximetry and electrocardiogram, but these aren't necessary for you to receive appropriate reimbursement.

And code G0244 has a new and improved description that loosens payment requirements. Instead of giving you a maximum of 48 hours, the new G0244 sets a minimum of eight hours and leaves the time restrictions at that. Old code: G0244 (Observation care provided by a facility to a patient with CHF, chest pain, or asthma, minimum of 8 hours, maximum 48 hours). New code: G0244 (... minimum 8 hours).
Remember that observation services begin when the staff places the patient in a bed, and end when the patient is either released or admitted as an inpatient. Don't include the time the patient spends waiting for transportation, says Lisa Marks, RHIT, CCS, with Precyse Solutions.
Also, keep in mind that when the patient receives observation care for more than two days, reporting the middle day can be sticky, says Susan Rohde, RHIT, CCS-P, CPC, consultant with Eide Bailly in Fargo, N.D. According to Principles of CPT Coding, "no specific listing exists in the CPT book for reporting the "middle day" of an observation stay. If the physician initiates observation status on Monday, continues to observe the patient on Tuesday, and discharges the patient from observation on Wednesday, then the E/M services provided on Tuesday should be reported with unlisted code 99499 [Unlisted E/M service]."

2. Mammographies are out.

Under the outpatient prospective payment system (OPPS) rule for 2005, Medicare will no longer pay for mammographies, including diagnostic computer-aided detection (CAD) services, performed in your facility under the OPPS. Instead, payment will be made under the Medicare Physician Fee Schedule.
3. Inpatient-only procedures can be outpatient procedures.

"The inpatient-only list is actually updated quarterly, but the majority of the revisions are at the year-end or at the beginning of the new year," Marks says. "We have 22 codes that are being removed from the list - that's quite a few."
So, if your facility performs any of the following procedures for a Medicare patient on an outpatient basis after Jan. 1, for those without [...]

- Published on 2005-03-22