Health Information Management

Will Medicare require "C" codes in 2005?

APCs Insider, October 1, 2004

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Will Medicare require "C" codes in 2005?

Question - Is it true that Medicare will require "C" codes for implants and devices starting in 2005? Any word?

Answer - Beginning in 2005, CMS is proposing to require hospitals to bill device-dependent procedures using the appropriate "C" codes for the devices. See Table 20 ("Proposed Device Codes Required for Select Device-Dependent APCs") in the Federal Register published August 16, 2004.  

CMS continues to require more outpatient data in order to construct future APC payments for high cost procedures with high cost implants/devices. In 2004, CMS strongly encouraged the reporting of "C" codes, and many hospitals heeded the recommendation and updated their chargemasters accordingly. If your facility is one that has not added the "C" codes to the appropriate items in your chargemaster, you should consider doing so this fall during your annual code review.

For 2005, CMS has taken the next step to require hospitals to report "C" codes information for a number of selected device-dependent APCs. This proposed requirement will help hospitals secure future APC reimbursement for device-dependent procedures.

Stay tuned for the finalization of the 2005 OPPS proposed rule sometime in November.

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