AHA Coding Clinic® for HCPCS - 2002 Quarter 4; FOR your INFORMATION
Changes in Medicare policy for Low Osmolar contrast material
A recent notification by CMS to all fiscal intermediaries on October 31, 2002, indicates that under the outpatient prospective payment system (OPPS) a payment difference between low osmolar contrast material (LOCM) and other contrast materials no longer exists since Medicare payment for all contrast media is packaged into the ambulatory payment classification (APC) for the diagnostic procedure. LOCM furnished on or after January 1, 2003 by hospitals subject to the OPPS should either include the charge for LOCM in the cost for the diagnostic procedure or, if billing for LOCM as a separate charge, bill using revenue code 255...
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Article Overview
This article covers a CMS notification to fiscal intermediaries about Medicare outpatient payment policy for low osmolar contrast material and other contrast media. It is relevant to hospital billing, outpatient prospective payment system (OPPS) reporting, and revenue code handling for diagnostic services. The article also identifies HCPCS reporting restrictions tied to the policy change and is useful for coders and revenue cycle staff tracking Medicare billing updates.
Why This Topic Matters
It helps billing and coding professionals understand a Medicare outpatient policy change that affects how contrast media is reported and packaged in hospital claims.
What You Will Learn
- How a CMS outpatient payment policy update affects contrast media billing
- Which hospital claim reporting areas are implicated by the change
- What general reporting constraints were noted for certain HCPCS contrast material identifiers
- How the update relates to OPPS packaging and diagnostic service billing
Who Should Read This
- Hospital outpatient coders
- Revenue cycle staff
- Billing compliance staff
- Medicare claims processing staff
Codes Discussed
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