Q/A: Note new HCPCS codes for outpatient procedures
APCs Weekly Monitor, August 5, 2011
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Q: Did CMS add any new HCPCS codes for hospital outpatient procedures effective July 1?
A: CMS Transmittal 2234 describes the following new services assigned for separate payment under OPPS:
- C9730, Bronchoscopic bronchial thermoplasty with imaging guidance (if performed), radiofrequency ablation of airway smooth muscle, 1 lobe
- C9731, Bronchoscopic bronchial thermoplasty with imaging guidance (if performed), radiofrequency ablation of airway smooth muscle, 2 or more lobes
Bronchial thermoplasty is a new, minimally invasive procedure for the treatment of severe asthma in adults. Radiofrequency energy is delivered to the distal airways to decrease smooth muscle mass believed to be associated with airway inflammation. This procedure is appropriate for the following individuals:
- Adult, severe persistent asthmatics
- Patients whose asthma is not well controlled despite a combination of inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA)
- Patients able to safely undergo bronchoscopy in accordance with hospital guidelines
CMS released these HCPCS codes and they are valid for assignment and coupled with APC 0415. It has a national payment of $1,971.77.
Understanding coverage is the key to this equation. Any hospital providing this procedure now or considering it for the future should contact its current Medicare Administrator Contractor (MAC) and other third-party payers to determine whether coverage is provided along with utilization requirements and limitations.
Note that coverage is not automatic simply because CMS establishes a HCPCS code with payment under OPPS. Exercising internal and external due diligence beyond any HCPCS code will help keep outpatient revenue compliant. Transmittal 2234 further states:
The fact that a drug, device, procedure or service is assigned a HCPCS code and a payment rate under the OPPS does not imply coverage by the Medicare program, but indicates only how the product, procedure or service may be paid if covered by the program. Fiscal Intermediaries (FIs)/Medicare Administrative Contractors (MACs) determine whether a drug, device, procedure or other service meets all program requirements for coverage.
Editor’s note: Denise Williams, RN, CPC-H, director of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.
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