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Other CMS and OIG Issuances

Medicare Weekly Update, December 28, 2007

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CMS proposes to expand coverage for home testing of prothrombin time international normalized ratio

On December 21, CMS issued a press release announcing a proposal to extend Medicare coverage for home testing of blood clotting tendencies for beneficiaries who require the use of warfarin, an anticoagulant (blood thinner) approved for use in the treatment of chronic atrial fibrillation (a specified heart rhythm irregularity) and venous thrombosis (a condition that commonly manifests as a blood clot in the leg).

View the press release.

Frequently asked questions

Last week, CMS issued the following new/revised frequently asked questions:

• When Correct Coding Initiative (CCI) edits for critical care and other services do not apply under the Outpatient Prospective Payment System (OPPS), is it appropriate for a hospital to report a pair of codes for which a CCI edit exists for physician payment? (view)
• How is the new or established patient classification determined under the Outpatient Prospective Payment System (OPPS)? For example, is a clinic patient considered new or established if he was treated in an off-site clinic of the hospital or the hospital's emergency department within the past 3 years? (view)
• Is it appropriate for a hospital to bill a visit code under the Outpatient Prospective Payment System (OPPS) for care provided to a registered outpatient if the patient was not seen by a physician? (view)
• What services are included in CPT code 99291 (critical care, first 30-74 minutes) and should therefore not be billed separately? (view)
• Is it appropriate for a hospital to bill an emergency department visit code for scheduled or anticipated care provided to a beneficiary in the hospital emergency department? (view)
• Do the critical care Correct Coding Initiative (CCI) edits apply to hospitals? (view)

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