ED Coding and Reimbursement Alert

Some Increase While Others Drop Based On Status Indicator Assignment

While all the 2016 payment changes for procedures can be found in Addendums A and B of the OPPS final rule, we list examples of common ED outpatient procedures and a payment comparison between 2015 and 2016. Many of these procedures have a status indicator of Q1 — conditionally packaged when reported with another service with a status indicator of V (visits) S or T (procedures).  Procedures having a status indicator of S or T will continue to be separately paid in the ED setting, explains Michael A. Granovsky, MD, FACEP, CPC, President of LogixHealth, a national ED coding and billing company based in Bedford, MA. 

*These Q1 procedures will be reimbursed only if the procedure is the only service provided and reported during the outpatient encounter.

Resource: Specific payment information by service is included in the final rule Addendums A (by APC) and B (by CPT^® code) in the link below.  Click on “CMS-1633-FC (Display Copy)”.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Regulations-and-Notices.html .