Corporate Compliance

Note from the instructor: Changes to device edits for July 2012

Medicare Insider, June 26, 2012

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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.

It was relatively quiet for CMS last week so I thought it would be a good idea to revisit one particular issue from the July OPPS Update transmittal on device-to-procedure edits.  There appears to have been an inadvertent “error” in the January and April OCE files that may have created problems for some providers trying to get reimbursed for the device HCPCS code C1882 - cardioverter defibrillator, other than single or dual chamber (implantable) when billed with CPT code 33249 - insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber.

A quick review of how the device edits came to be: Since January 1, 2007, CMS has required that devices contained in the device-to-procedure or procedure-to-device edit list cannot be correctly reported without one of the specified procedure codes also being reported on the same claim. Prior to 2007, when devices were billed without an appropriate procedure code, the cost of the device was being packaged into the median cost for an incorrect procedure code which was inflating the payment for the incorrect procedure code. Hospitals that billed devices without the appropriate procedure code were being incorrectly paid as well. The device-to-procedure edits were created to ensure that the costs of specific devices were assigned to the appropriate APC for rate setting. Under the current system, failure to pass these edits will result in the claim being returned to the provider (RTP) for correction.

Continue reading Debbie's note at the Medicare Mentor Blog.

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