AHA Coding Clinic® for HCPCS - 2005 Quarter 3
CMS mandates device code reporting
Effective for services provided on or after April 1, 2005, any hospital paid under the Outpatient Prospective Payment System (OPPS) must report a device code when reporting a code for insertion of a device. Edits have been installed into the outpatient code editor (OCE) for services on or after April 1, 2005, that will not allow claims to be processed for payment if the device code is not reported by OPPS hospitals. However, special conditions apply for hospitals that insert surgical devices that do not incur any costs for the devices. Some scenarios include, but are not limited to:...
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Article Overview
This article covers CMS outpatient prospective payment guidance on device code reporting for hospital claims, with attention to claim processing edits effective in 2005 and special handling when a device is furnished at no cost. It is relevant to hospital outpatient billing staff, coders, and revenue cycle teams who need to understand the general reporting requirements, the role of HCPCS device coding, and the types of no-cost scenarios addressed by CMS. The discussion also points readers to related CMS transmittal guidance.
Why This Topic Matters
Hospitals paid under OPPS needed to adapt to CMS claim edits that affected payment if device reporting was missing, and this guidance also addressed how to handle no-cost device situations so claims would process correctly.
What You Will Learn
- How CMS describes device reporting expectations for outpatient hospital claims
- What general categories of no-cost device situations are addressed
- How CMS relates the guidance to outpatient claim processing and transmittal material
- What broad billing circumstances are discussed for hospital-implanted devices
Who Should Read This
- Hospital outpatient coders
- Revenue cycle staff
- Billing compliance teams
- Healthcare reimbursement professionals
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