Health Information Management

Tip: CMS updates comprehensive APC logic for add-on codes

APCs Insider, May 8, 2015

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A change CMS made to the I/OCE specifications earlier this year corrects the processing for add-on codes used as the secondary procedure for applying complexity adjustments for comprehensive APCs (C-APC). Originally, CMS was not applying the complexity adjustment for these codes.
 
The change impacts 10 code pairs that include certain add-on codes as the secondary service. Providers should review claims CMS processed in the first two weeks of January to determine whether any claims included these add-on codes along with other J1 (hospital Part B services paid through a C-APC) services.
 
There's a two-week period where it's possible providers could have used these codes. The changes were made retroactive to January 1, so providers should consider reviewing and resubmitting any affected claims.
 
This tip is adapted from “CMS releases update to correct and clarify comprehensive APC payments" in the May issue of Briefings on APCs.



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