OPPS UPDATEs: Ready Your CDM for July OPPS Updates, New HCPCS Codes and Observation Guidelines Hit the Stage

Just when you're comfortable with last quarter's changes, CMS introduces new material. Take this handy highlights tour to keep your staff in-the-know about the new codes, old codes, regulatory updates, and corrections that take effect July 1.
 

 Quite a few HCPCS codes make their debut, several of which are significant procedures:
 
C1818 Integrated keratoprosthesis (This one brings the total number of pass-through codes to 10).
 
APC: 1818, Status indicator (SI): H
 
C8918 Magnetic resonance angiography with contrast, pelvis
 
APC: 0284, SI: S
 
C8919 ... without contrast, pelvis
 
APC: 0336, SI: S
 
C8920 ... without contrast, followed by with contrast, pelvis
 
APC: 0337, SI: S
 
C9205 Injection, oxaliplatin, per 5 mg

 APC: 9205, SI: G
 

 The new K codes K0606-K0621 all have status indicator A.
 

 Two C codes are off the stage, and two Q codes take their places: C1207 (Octreotide acetate depot 1 mg) gets replaced by Q4052 (Injection, octreotide, depot form for intramuscular injection, 1 mg), and Q4053 (Injection, pegfilgrastim, per 1 mg) takes over for the retired C9119 (Injection, pegfilgrastim).
 

 Yes, even more clarification about the observation service regs:
 
First, you no longer need modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) with G0263 (Direct admission of patient with diagnosis of congestive heart failure, chest pain or asthma for observation) to get paid for G0244 (Observation care provided by a facility to a patient with congestive heart failure, chest pain, or asthma, minimum eight hours, maximum forty-eight hours).
 
You've also got a narrower time frame in which to perform diagnostic services on the day before the patient's admission to observation these services won't always meet the requirements for separate observation payment. The new period starts on the date of the E/M visit or the date you admit the patient to critical care or observation, and ends after the patient has been under observation for 24 hours. The exception: If the E/M visit is the day before observation started for example, a late-night emergency department patient the diagnostic services will count. The "day-before" rule is to distinguish between diagnostic services for that theoretical ED patient and, say, a patient directly admitted to observation from a doctor's office who got diagnostic services the day before.
 

 Drug-eluting stents (DES) hit the radar for real this time, so be aware of these rules:

For outpatient services performed before July 1, you have two choices to get paid for DES. You can keep billing the stents with 92980 (Transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel) and +92981 (... each additional vessel), and include the stent charge in [...]

- Published on 2003-06-01