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Get ready for payment impact of status indicator "Q"

APCs Weekly Monitor, August 10, 2007

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Question: Could you explain the significance of status indicator "Q" (SI "Q") services, as detailed in the 2008 OPPS proposed rule?

Answer: In the 2007 OPPS final rule, CMS assigned SI "Q" to eight HCPCS codes.  Physicians and other staff occasionally provide these services (for which payment is packaged as SI "N" and SI "Q") under the OPPS, at the same time as one or more other procedures.

For 2008, CMS defines services that have an SI "Q" as "special" packaged codes. CMS has proposed to expand the number of HCPCS codes with an SI of "Q" from eight to 150. In 2007, CMS packaged (SI "N") 849 services/items. For 2008, CMS is proposing to package more than 1,000 services/items.

Payment for HCPCS codes with SI "Q" is packaged when you report additional HCPCS codes with SIs "V," "X," "S," or "T" on the claim with the same date of service. If a HCPCS code with SI "Q" appears on a claim that does not include a HCPCS code with an SI of "V," "X," "S," or "T," then the HCPCS code with SI "Q" will trigger separate APC payment.

For 2008, CMS proposes to expand this concept of special packaging into the following seven categories:

• Guidance services (Table 8 of the OPPS proposed rule)
• Imaging process services (Table 10)
• Intraoperative (Table 12)
• Image supervision and interpretation services (Table 14)
• Radiopharmaceuticals (Table 17)
• Contrast agents (Table 19)
• Observation services (HCPCS code G0378) 

Review the clinic, same-day surgery, and observation examples provided here: http://ezines.hcpro.com/images/doc/eapc_comparison_examples.xls in order to see the revenue impact from 2007 to 2008 associated with SI "Q" and SI "N" services.  Examine the tables in this link and construct your own examples to prepare your facility for the financial impact.  We urge all of our readers to comment to CMS regarding this extensive packaging concept and its impact on hospital revenue.

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