Health Information Management

CMS proposes changing supervision levels for several procedures

APCs Insider, April 25, 2014

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By Steven Andrews, Editor

CMS has proposed changing the supervision levels of several services as a result of the recommendations of the latest meeting of the Hospital Outpatient Payment (HOP) Panel.

The group met in March to make its recommendations to CMS, which released its preliminary decisions for providers to comment on through April 30.

CMS accepted the panel's proposal to change the following services from direct to general supervision:

  • G0176, activity therapy, such as music, dance, art or play therapies not for recreation related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more)
  • 36593, declotting by thrombolytic agent of implanted vascular access device or catheter
  • 36600, arterial puncture, withdrawal of blood for diagnosis
  • 94667, manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation
  • 94668, manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent

This means that the procedures must be given under a physician or non-physician practitioner’s overall direction and control but does not require his or her presence during the service.

The panel also recommended switching eight chemotherapy administration service to general supervision, but CMS did not propose to change them. The majority of physicians on the panel voted in favor of direct, rather than general, supervision and expressed concerns about the safety of general supervision for chemotherapy, especially without a quality standard or guideline from oncology associations endorsing general supervision.

However, the agency did specifically request public comment on this issue in order to determine whether it should continue to require direct supervision.

The panel also recommended general supervision for a debridement service:

  • 97597, debridement, open wound, including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less

Since this procedure included debridement with a sharp instrument, CMS did not approve this recommendation, writing that it "is not generally within nursing scope of practice" and not safe for general supervision.

To read more of the panel's recommendations, see CMS' website. To submit a comment to CMS before April 30, email HOPSupervisionComments@cms.hhs.gov. CMS' recommendations will be implemented July 1.



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