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OPPS Update Means Changes for Radiology, Pass-Throughs

The latest quarterly OPPS update issued by CMS contained a number of changes that benefit hospitals, once they get over the hassle of incorporating the changes into their chargemasters and coding practices. The full 23-page list of changes is published in Transmittal A-01-73 dated June 1, 2001. Most changes became effective July 1, although a few go into effect Oct. 1.

Changes and Additions for Radiology APCs
 
Coding for radiological procedures is one of the areas most affected by the latest revisions to the OPPS. CMS made the changes because the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) required the agency to distinguish between radiological procedures that are performed with and without contrast media. Melody Mulaik, MHSH, CPC, president of Coding Strategies Inc. in Dallas, Ga., says the changes bring the OPPS more in line with the terminology used in radiology departments. "It is a more accurate classification," she says. Reimbursement could also be affected by the new APCs into which the procedures have been grouped.
 
To achieve BIPA's mandate, CMS has revised APC 0283, now titled computerized axial tomography with contrast, and APC 0284, now titled magnetic resonance imaging and angiography with contrast, to include imaging procedures only performed with contrast media. To complete the change, 71 radiology procedures that don't use contrast, or are performed initially without contrast, were switched from APCs 0282, 0283 and 0284 to six newly created APCs (see table on page 69). These changes were effective July 1.
 
In addition, beginning Oct. 1, new C codes will go into effect exclusively for hospital use in billing radiology procedures that are performed with or without contrast. These C codes, C8900-C8914, will replace five of the seven HCPCS codes assigned to the new APC 0338 (magnetic resonance angiography and imaging with contrast).
 
The HCPCS codes affected are:
 

71555 -- magnetic resonance angiography, chest (excluding myocardium), with or without contrast
 

73725 -- magnetic resonance angiography, lower extremity, with or without contrast
 

74185 -- magnetic resonance angiography,  abdomen, with or without contrast
 

76093 -- magnetic resonance imaging, breast, without and/or with contrast; unilateral
 

76094 -- magnetic resonance imaging, breast, without and/or with contrast; bilateral
 
Another reshuffle effective Oct. 1 involves seven computed angiography procedures that will be shunted from the new APC 0332 to APC 0333. However, the payment rates will remain the same.

PET Scan Reimbursement Increases
 
In another change related to radiology, new HCPCS codes, G0210-G0230, have been assigned to PET scans. With this change, according to Mulaik, CMS has expanded the types of cases that it will cover. "For example, in the past, CMS would only cover PET scans for a recurrence of colorectal [...]

- Published on 2001-09-01