Radiology Coding Alert

CMS clarification shakes up outpatient physician supervision.

The 2009 Outpatient Prospective Payment System (OPPS) includes a clarification that is stirring up a lot of concern for hospitals.

The gist: CMS says that all hospital outpatient departments, including those within the hospital, must abide by physician supervision rules, says Jackie Miller, RHIA, CCS-P, CPC, vice president of product development for Coding Metrix in Powder Springs, Ga.

Source of confusion: As CMS acknowledges in the 2009 OPPS, CMS has previously stated, "we assume the physician supervision requirement is met on hospital premises because staff physicians would always be nearby within the hospital."-For years, providers have interpreted that to mean that the rules on physician supervision of diagnostic tests only applied in the nonhospital and off-campus hospital outpatient department setting because in the hospital physicians would always be available.

But CMS now says that people have misconstrued the policy and that all hospital outpatient departments, including those that are within the hospital, must abide by the supervision rules, Miller says.

So if the physician fee schedule says a code requires direct supervision (such as the technical component of 74160, Computed tomography, abdomen; with contrast material[s]), this "means that the physician must be present and on the premises of the location and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed."

'On the premises': CMS states that "'on the premises of the location' means that the physician must be present on the premises of the entity accorded status as a department of the hospital. This means that the physician must be present in the provider-based department."

Resource: You can find the 2009 OPPS clarification online at www.cms.hhs.gov/HospitalOutpatientPPS/Downloads/CMS-1404-FC.pdf, beginning on page 808. The official version is published in the Nov. 18 Federal Register at http://edocket.access.gpo.gov/2008/pdf/E8-26212.pdf, beginning on page 68702.