Health Information Management

January OPPS update notes changes for 2014

APCs Insider, January 17, 2014

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CMS recently released MLN Matters® article 8572, covering the numerous January updates to the OPPS that were introduced in the 2014 OPPS Final Rule.
With the rule’s release delayed due to the government shutdown, providers have had a shortened window this year to implement payment and billing changes, meaning the January update should be carefully reviewed.
CMS proposed radical changes to E/M services by collapsing the levels for all visits, but only finalized collapsing clinic E/M visits. CMS will now only recognize HCPCS code G0463 (hospital outpatient clinic visit for assessment and management of a patient) for payment under the OPPS for outpatient hospital clinic visits. As of January 1, CMS will no longer recognize CPT® codes 99201-99205 and 99211-99215 for payment under the OPPS.
CMS also eliminated two extended assessment and management (EAM) encounters through APCs 8002 (level I EAM composite) and 8003 (level I EAM composite) January 1, replacing them with APC 8009 (EAM composite). The new code should be used for clinic visit (G0463), a Level 4 (99284) or Level 5 Type A ED visit (99285), or Level 5 Type B ED visit (G0384) provided by a hospital in conjunction with observation services lasting eight hours or longer.
Providers should also pay attention to the latest device and procedure edits. CMS has updated the lists on its website. They should also be aware that, effective January 1, nuclear medicine procedure-to-radiolabeled product edits are no longer required. However, hospitals should still adhere to coding guidelines and include the correct product codes when applicable. CMS will no longer return claims without HCPCS codes for radiolabeled products for nuclear medicine procedures.
To see all of the changes, including updates to modifiers, new drug codes, additional edit changes, and more, see the MLN Matters article.

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