AHA Coding Clinic® for HCPCS - 2005 Issue 4

CMS clarifies the usage of modifier -CA

The Centers for Medicare & Medicaid Services (CMS) created HCPCS modifier -CA January 2003, for situations where a procedure on the outpatient prospective payment system (OPPS) inpatient only list is performed to resuscitate or stabilize an outpatient with an emergent, life-threatening condition, and the patient dies before being admitted as an inpatient. On November 2003, CMS created APC 0375, Ancillary outpatient services when patient expires, to ensure the appropriate payment for services rendered on the same date as procedure(s) with a status indicator (SI) of “C” billed with modifier -CA. Additionally, hospitals were instructed to use modifier -CA...

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