Corporate Compliance

Note: OPPS proposed rule affects imaging payments

Medicare Insider, July 19, 2011

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Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor.

In 2011, the AMA introduced three new CPT codes for computed tomography (CT) of the abdomen and pelvis with and without contrast. These codes are currently being paid using the existing data from prior CPT codes which unfortunately are not reflecting the true cost to the hospitals for performing these combination services. After further review of the claims data for these “new services” and carefully reconsidering the providers’ comments during the 2011 OPPS proposed rule, CMS is proposing to create two new APCs to more accurately reflect the costs and the efficiencies of performing these services under the combined codes – one APC for the service without contrast and another APC for the services provided with contrast based on current statutes.

Continue reading Debbie's note on the MedicareMentor Blog.



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