Effective July 1, physician offices and other Part B entities wholly owned or operated by a hospital must append modifier PD Diagnostic or related nondiagnostic item or service provided in a wholly owned or operated entity to a patient who is later admitted as an inpatient within 3 days to codes for diagnostic or related non-diagnostic items or services furnished to a Medicare patient who is later admitted as an inpatient within a three-day payment window.
June 29th, 2012
The Centers for Medicare & Medicaid Services (CMS) has established new payment modifier PD Diagnostic or related nondiagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days. Physicians, suppliers, and providers are now required to append modifier PD to preadmission diagnostic and admission-related nondiagnositic services reported with HCPCS Level II or CPT® codes subject to the 3-day payment window policy.
Modifier PD is available for claims with dates of service on or after Jan. 1, 2012. This is changed from the effective date of Jan. 10, 2012, established in CMS Transmittal 2297. CMS advises entities to begin coordinating their billing practices and claims processing procedures with their hospitals to ensure compliance with the 3-day payment window policy no later than for claims received on or after July 1, 2012.
When modifier PD is present on claims for service, Medicare will pay:
- Only the professional component (PC) for CPT®/HCPCS Level II codes with a technical component (TC)/PC split that are provided in the 3-calendar day (or, 1-calendar day) payment window; and
- The facility rate for codes without a TC/PC split.
See MLN Matters MM7502 for background information relating to the 3-day window payment policy. AAPC’s Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CHCC, CENTC, offers additional guidance.
January 13th, 2012
The new three-day payment rule may be part of the 2011 Inpatient Prospective Payment System (IPPS) final rule but outpatient coders are not immune. The new rule requires inpatient and outpatient coders to work together to avoid improper claims payment.
Michelle A. Leppert, CPC-A, senior managing editor for justcoding.com talks with Jennifer Hume, CPC, CPMA, CEMC, vice president of auditing and compliance at AAPC Physician Services, and Mary Phelps, RHIA, CCS, CIRCC, CTR, CCDS, manager at PricewaterhouseCoopers, about the implications the three-day payment window has on outpatient coding.
“Know potential outpatient implications of the three-day payment rule” is a free article posted Nov. 3 on justcoding.com.
November 3rd, 2010