Health Information Management

Special report: APC Panel debates requiring HCPCS drug codes for packaged services

APCs Insider, August 19, 2011

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Should CMS require hospitals to report HCPCS codes for packaged services? This topic generated plenty of discussion during the August 12 APC Advisory Panel on Ambulatory Payment Classification Groups meeting.

Currently, facilities do not need to report HCPCS codes for packaged services, including drugs, even when a HCPCS code exists.

The debate over whether the panel should recommend that CMS require reporting of the HCPCS codes generated the most intense debate during the two-day meeting, according to Kimberly Anderwood Hoy, Esq., director of Medicare and compliance at HCPro, Inc., in Danvers, MA. “It was really hotly debated,” says Hoy, who made her only comment during the discussion. “Some people had really strong opinions.”

One attendee meeting suggested that instead of worrying about reporting HCPCS codes for packaged services, hospitals should focus on clinical software to help clinicians do their job. When the clinical piece is in place, the commenter argued, then hospitals can worry about integrating the reporting of HCPCS codes for packaged services.

Hoy responded with a comment based on her experience purchasing software for a hospital. “If you make it required, the software vendors will add it to the software,” Hoy says. “Until you make it required, you’ll never have that integration where the clinical piece will be integrated.”

Other attendees expressed concern about the burden reporting these HCPCS codes would represent to hospitals, Hoy says. Because the services are packaged, hospitals don’t receive additional reimbursement even when they report HCPCS codes for drugs and other packaged services. “Interestingly, everyone from the provider side who was there and commented said it wasn’t a burden on hospitals,” Hoy says.

Kathy Dorale, RHIA, CCS, CCS-P, vice president of HIM at Avera Health System in South Dakota, noted that hospitals ultimately code the National Drug Code anyway for many drugs.

Providers said it wouldn’t be a burden, while members of the panel said it would be, Hoy recalls. The panel didn’t actually approvie anything with CMS because it wasn’t sure how or whether CMS would enforce it, Hoy says.

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