Health Information Management

Q&A: Are there changes for skin substitute reporting in 2014?

APCs Insider, December 20, 2013

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Q: Are there any changes for skin substitute application reporting for 2014? We are hearing rumors that there are a lot of changes this year.

A: There are changes for reporting skin substitute procedures for 2014 according to the 2014 OPPS Final Rule, published in the Federal Register on December 10. Under the finalized policy changes, skin substitutes will be packaged into the procedures representing the application. The exception to this is if an item has pass-through status. In the case of pass-through status, the line item will be paid and the device offset will be removed from the APC payment for the procedure.

CMS noted that some skin substitutes cost more than others, and has grouped these items into “high-cost” and “low-cost” groups. Table 13 in the final rule identifies each item as high or low cost. Beginning January 1, 2014, skin substitutes designated as high cost will be reported with the CPT® codes for skin substitute application (15271–15278). Those designated as low cost will be reported with new C-codes C5271–C5278. The new C-codes have the same description as the CPT codes with the designation of “low-cost” skin substitutes.

CMS is also implementing claims processing edits to ensure that high-cost skin substitutes are reported with the CPT codes and low-cost skin substitutes are reported with the HCPCS Level II C-codes. Any skin substitutes receiving pass-through payment should be reported with the CPT codes.

Editor’s note: Andrea Clark, RHIA, CCS, CPCH, chairman, CEO, and founder of Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.



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