Health Information Management

Tip: CMS looks to add new modifier to identify services performed prior to C-APCs

APCs Insider, September 11, 2015

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CMS notes that as comprehensive APC (C-APC) policies expand, the agency needs a way to identify adjunctive services provided prior to the associated primary (J1) procedure so it can compute the single C-APC encounter or "bundled payment" more accurately in the future.
CMS defines these adjunctive services as those that are integral, ancillary, supportive, and dependent to a comprehensive service before it's performed—such as testing leads for a pacemaker insertion or planning related services associated with stereotactic radiosurgery procedures.
CMS proposes to release a new HCPCS modifier that providers would report with every code that's adjunctive to a comprehensive service but billed on a different claim. 
This tip is adapted from “Commenting to CMS on OPPS is more important than ever" in the September issue of Briefings on APCs.

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