Health Information Management

Tip: CMS updates comprehensive APC logic for add-on codes

APCs Insider, May 8, 2015

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

A change CMS made to the I/OCE specifications earlier this year corrects the processing for add-on codes used as the secondary procedure for applying complexity adjustments for comprehensive APCs (C-APC). Originally, CMS was not applying the complexity adjustment for these codes.
The change impacts 10 code pairs that include certain add-on codes as the secondary service. Providers should review claims CMS processed in the first two weeks of January to determine whether any claims included these add-on codes along with other J1 (hospital Part B services paid through a C-APC) services.
There's a two-week period where it's possible providers could have used these codes. The changes were made retroactive to January 1, so providers should consider reviewing and resubmitting any affected claims.
This tip is adapted from “CMS releases update to correct and clarify comprehensive APC payments" in the May issue of Briefings on APCs.

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular