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C codes now required for specific device-dependent procedures

APCs Weekly Monitor, December 10, 2004

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C codes now required for specific device-dependent procedures

Q: Are C codes for implants and devices utilized during a device-dependent APC procedure now required for 2005?

A: Medicare has wavered back and forth with C codes for implants and devices since the inception of OPPS in August 2000. But beginning January 1, 2005, Medicare will require 35 selective C codes to be reported with device-dependent APCs. See Table 19 of the OPPS final rule (available in the November 15 Federal Register) for the complete listing of C codes for implants and devices.  Medicare resurrected those C codes deleted as of January 1, 2003, with a status indicator of N.

Providers should also note that beginning April 1, 2005, you must report specific HCPCS codes in association with C codes for implants and devices, or they will not pass OCE edits.  See Table 20 of the November 15 Federal Register for specific edits.

In the OPPS final rule published November 15, 2004, Medicare stated the following:

 The OCE will not go into effect into April 1, 2005. This gives providers the time to prepare for when certain procedure codes must be accompanied by an associated device category code.

 Edits will apply at the CPT/HCPCS level rather than APC level.

 Edits will not apply when modifiers -73 or -74 are present.

 If one device is shown for one APC, that device would have to be billed on the claim for a service in that APC or the claim would be returned to the provider for correction. See Table 20.

 If more than one device is shown for one APC, the provider would be required to bill one of the device codes shown on the same claim with the service in that APC for the claim to be accepted. See Table 20.

 We are considering expanding the device coding requirements in the future. We believe that requiring device coding for a small subset of device-dependent APCs each year would minimize annual coding burdens and begin to improve data for these APCs, which have consistently proven to be problematic.

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