Reader Question: Minor Procedures

Question: Due to APCs, we have stopped including minor procedures in our facility levels and we now code each one separately. Some employees in finance have told us that we should not code certain procedures because they are not considered significant and are integral to the facility level charged. These include 90780, 90781, 90471, 90472, 94760 and 94761. Should we be coding all procedures, including minor ones?

Jan Mitch
Pittsburgh

Answer: Certain services are considered packaged (status indicator N) under the Outpatient Prospective Payment System (OPPS), meaning that Medicares payment for the procedure is captured in the payment for whatever other services you provide during the same encounter. The procedures on your list that this would apply to are 90471 (immunization administration [includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections and/or intranasal or oral administration]; one vaccine [single or combination vaccine/toxoid]), 90472 (each additional vaccine [single or combination vaccine/toxoid]), 94760 (noninvasive ear or pulse oximetry for oxygen saturation; single determination) and 94761 (multiple determinations [e.g., during exercise]).

The decision as to whether coding these packaged services is worth the effort is up to the individual facility. Although packaged services are not individually paid under APCs, they are covered services and, although not likely in the case of the minor procedures on your list, capturing charges for some packaged services could possibly affect outlier and transitional corridor payments.

However, there are other issues involved with some of the codes mentioned in your question. CPT codes 90780 (IV infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) and 90781 (each additional hour, up to eight hours) have an APC status indicator of E (noncovered items and services). The correct code to use for reporting infusion therapy to Medicare is HCPCS code Q0081 and not 90780-81. Q0081 has a national payment rate of $80.49 so it is certainly worth coding this procedure. Also, although 90471 and 90472 (administration of vaccines) are packaged services, G0008 (administration of influenza virus vaccine) has a status indicator of X (ancillary service) and a national payment rate of $6.19.


- Published on 2000-12-01