Health Information Management

Q&A: Which edits did CMS discontinue for 2014?

APCs Insider, January 17, 2014

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Q: Did CMS discontinue the device-to-procedure and radiopharmaceutical-to-nuclear medicine procedure edits for 2014? CMS said these would be discontinued in the proposed rule.
 
A: CMS did propose to eliminate these edits for 2014 when it proposed the comprehensive APCs. CMS explained that hospital providers have had several years to report services and devices correctly and the edits should no longer be required. The final rule states
 
As with all other items and services recognized under the OPPS, we expect hospitals to code and report their costs appropriately, regardless of whether there are claims processing edits in place.
Hospitals would still be expected to adhere to the guidelines of correct coding and append the correct device code to the claim when applicable.
 
However, with the delayed implementation of the comprehensive APCs, and based on commenter feedback, CMS postponed eliminating the edits and will reevaluate the idea for next year.
 
Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.



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