Health Information Management

CMS assigns "special" designation to six packaged codes

APCs Insider, December 22, 2006

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CMS assigns "special" designation to six packaged codes

QUESTION: Did CMS finalize any changes to packaged services in the 2007 OPPS final rule?

ANSWER: CMS finalized the following six CPT codes as "special" packaged codes in 2007. CMS assigned these codes status indicator Q in Addendum B, meaning they will remain packaged (not separately paid) when provided with another OPPS service, just as they are today. However, if these are the only codes reported on a claim without another OPPS service, the outpatient code editor will change their status from Q to the following assignments, rendering them separately payable:

  • 36540: Collect blood, venous access device, APC 0624, status indicator S, $31.44
  • 36600: Arterial puncture; withdrawal of blood for diagnosis, APC 0035, status indicator T, $12.22
  • 38792: Sentinel node identification, APC 0389, status indicator S, $84.05
  • 75893: Venous sampling through catheter, with or without angiography, radiological supervision and interpretation, APC 0668, status indicator S, $381.71
  • 94762: Noninvasive ear or pulse oximetry for oxygen saturation by continuous overnight monitoring, APC 0443, status indicator X, $63.61
  • 96523: Irrigation of implanted venous access device, APC 0624, status indicator S, $31.44

If you report two of the above codes together on a claim without another OPPS service, only the highest weighted APC will be paid. The other service will be packaged.

CMS also makes it clear that hospitals should not report a low-level E/M code when a provider only renders a packaged service. The Final Rule states the following: "Providers should bill a low-level visit code in such circumstances only if the hospital provides a significant, separately identifiable low-level visit in association with the packaged service."

Based on this new requirement and grouping method, review the above CPT codes and address this change with the appropriate department. All facilities should perform an audit during the first quarter of 2007 to ensure APC revenue integrity.



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