Health Information Management

Q/A: Laparascopic bariatric surgery removed from inpatient-only

APCs Insider, September 21, 2012

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Q: In the October OPPS update transmittal, they note that laparascopic bariatric surgery is going to be reimbursable as an outpatient procedure. I thought CMS only changed these statuses with the yearly OPPS update. Did CMS change its policy?

A: The process has not changed. Under the OPPS, notification of procedures that are being moved off the inpatient-only list occurs during the yearly update, and the change is effective on January 1.
This change was made in the CY 2012 OPPS final rule and the status indicator was changed in the January 2012 Addendum B file. 
 Line items with a change to status indicator and/or APC assignment are noted by “CH” in the “CI” column of addendum B, as well as being detailed in the narrative of the final rule. Transmittal 2531 notes that the language in the Medicare Claims Processing Manual (pub 100-04) is being updated to reflect that this procedure is reimbursable when performed as a hospital outpatient.
Remember that payment rates being established in Addendum B for outpatients does not guarantee reimbursement.  The documentation for the procedure must also meet any National or Local Coverage Determinations (NCD or LCD) coverage requirements. Addendum B status indicators describe whether a service is paid under the OPPS, fee schedule, or as an inpatient only; the status indicator and APC assignment do not address any coverage requirements.
Editor’s note: Andrea Clark, RHIA, CCS, CPCH, chairman, CEO, and founder of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.

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