Cardiac computed tomography (CCT) professionals will see major changes in coding next year. CPT® 2010 adds four new Category I codes to report CCT and cardiac computed tomography angiography (CCTA) services and deletes four Category III codes.

In a statement posted on its Web site prior to the Oct. 30 release of the 2010 Outpatient Prospective Payment System (OPPS) final rule, the Society of Cardiovascular Computed Tomography (SCCT) said it did not foresee significant changes in payment for CCT/CCTA. They were singing another tune Nov. 2.

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Hospitals who successfully participated in quality data reporting for outpatient services will receive a 2.1 percent inflation update in their 2010 payment rates for services furnished to Medicare beneficiaries in outpatient departments, according to the Centers for Medicare & Medicaid Services (CMS). Ambulatory surgical centers (ASCs) will receive a 1.2 percent inflation update beginning Jan. 1, 2010 using the same payment methodology as in 2009.

These and other payment and policy changes can be found in the 2010 Hospital Outpatient Prospective Payment System (OPPS) and ASC final rule with comment period — put on display for review Oct. 30.

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A minor software problem resulted in the non-transmittal of some public comments on two proposed rules submitted between July 26-30 via www.regulations.gov.

The problem has been corrected and the Centers for Medicare & Medicaid Services (CMS) is requesting the public resubmit their comments on the 2010 Physician Fee Schedule or 2010 Hospital Outpatient Prospective Payment System/Ambulatory Surgical Center Payment System proposed rule before the close of the comment period for these rules (Aug. 31, 2009).

Click here for information on how to resubmit public comment on either of these two proposed rules.

The Centers for Medicare & Medicaid Services (CMS) proposed, July 1, several policy and payment rate changes for hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) for fiscal year 2010. Payment rate increases for providers paid under the Outpatient Prospective Payment System (OPPS) and expanded coverage for certain Medicare services furnished in HOPDs and ASCs are projected in the 2010 proposed rule. Read more »

The Centers for Medicare & Medicaid Services (CMS) released the July 2009 Integrated Outpatient Code Editor (I/OCE) Specifications, version 10.2. This quarter’s update hosts a number of noteworthy changes that go into effect July 1. Read more »

A recent review conducted by Trailblazer, the A/B Medicare Administrative Contractor (MAC) for jurisdiction four (J4), shows hospitals are ultimately confused as to where to draw the line between inpatient and outpatient status. Even more recent editorial changes to the Medicare Claims Processing Manual may help hospitals clarify the terms “observation” and “admission.” Read more »

The July 2009 update of the hospital Outpatient Prospective Payment System (OPPS) implements a number of changes to and billing instructions for various Medicare policies. The most affected areas of note are drugs and biologicals and Part B hospital outpatient services.

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A North Carolina fiscal intermediary incorrectly paid 89 of 91 Medicare claims for oxaliplatin services reviewed in an Office of Inspector General (OIG) audit. Prior to the April 23 report, implicated hospitals had already identified and refunded $1,762,070 in overpayments to Palmetto GBA. The OIG has requested Palmetto GBA recapture the remaining overpayments totaling $160,096.

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A Recurring Update Notification (RUN) released March 13 by the Centers for Medicare & Medicaid Services (CMS) describes important coding and billing changes and instructions for various payment policies implemented in the April 2009 Outpatient Prospective Payment System (OPPS) update.

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The Centers for Medicare & Medicaid Services (CMS) updated the outpatient therapy cap exception policy and dollar amount for 2009.

Effective Jan. 1, the allowed outpatient therapy dollar limits, excluding outpatient hospital services, for physical therapy and speech-language pathology combined is $1,840 and for occupational therapy is $1,840. Providers who perform services meeting the exceptions criteria and report modifier KX Specific required documentation on file will be paid beyond this limit.

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