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OPPS Update: Enjoy Today's Outpatient Special: A Delicious 4.5 Percent Payment Hike

Feast on the highlights of the OPPS final rule for 2004

According to the Nov. 7 Federal Register, your facility can count on a 4.5 percent aggregate payment increase for outpatient services come Jan. 1, 2004. This isn't the only major change in the year's final rule for the outpatient prospective payment system (OPPS): CMS also increases the number of ambulatory payment classifications (APCs), toys briefly with drug administration, and increases the number of separately payable medications.

No facility evaluation and management changes yet - CMS says it will continue to study the issue, choosing not to put into effect any G codes for emergency department and clinic visits. So don't expect implementation of new E/M guidelines until at least Jan. 1, 2005.
Breathe Easy With New Chemo Rules
Coding chemotherapy will never be the same again: Q0085 (Chemotherapy administration by both infusion technique and other technique[s], per visit) gets the ax in 2004, but you should continue to report codes Q0083 (Chemotherapy administration by other than infusion technique only, per visit) and Q0084 (Chemotherapy administration by infusion technique only, per visit) instead. And unlike the proposed rule, the final rule keeps these two codes - as well as Q0081 (Infusion therapy, using other than chemotherapeutic drugs, per visit) - as "per visit" instead of the former "per day."
"The chemo change is going to make billing a little easier" for facilities, because non-Medicare carriers generally use codes in the 964xx CPT range, which breaks out injection/push services from infusion ones, says Sarah L. Goodman, MBA, CPC-H, CCP, president of SLG Inc. in Raleigh, N.C. Moreover, she says, "The 'per visit' versus the 'per day' on the Q codes will be good for those patients requiring two to three visits in a 24-hour period, such as those receiving Vancomycin IV."
Check With FIs for C Codes
Despite commentators' protests to CMS that reinstatement of category C codes would place unnecessary administrative burdens on facilities - without earning the reimbursement to make up for the trouble - the codes are back in business. The twist: Providers have a choice as to how to use them,  Goodman says. Non-Medicare intermediaries may or may not adopt them under the Health Information Portability and Accountability Act (HIPAA).
The effects of the optional reinstatement are ambiguous. For instance, one commentator to CMS objected that "widespread confusion over what device to code and what device not to code" is why claims that could include pass-through device codes often don't.
As a result of the confusion, "many hospitals did not comply even when the use of the code would have resulted in separate payment." So despite CMS' statement regarding [...]

- Published on 2004-01-01