Health Information Management

Q&A: How will CMS handle device edits related to procedures in 2016?

APCs Insider, December 4, 2015

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A: CMS is not going to resurrect or reinstate the device-to-procedure edits for all procedures that use a device. CMS notes in the 2016 OPPS final rule that it expects to see the appropriate and correct device code reported on a claim, even without the edits. CMS believes that hospitals have had enough experience with these edits, requirements, and coding for devices and procedures to submit a correct claim that reflects the procedure performed and the devices used.
For 2016, CMS continues to refine the device-to-procedure edits. To trigger an edit in 2016, the procedure must be assigned to a device-intensive APC and requires the implantation of a device. Any of the device codes on the list will continue to satisfy the edit, but the edit won’t trigger in the claims processing system unless these two criteria are met.
Table 42 in the final rule includes a list of the 2016 device intensive APCS.


Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Revant Solutions,in Fort Lauderdale, Florida, answered this question.

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