AHA Coding Clinic® for HCPCS - 2005 Quarter 4; FOR your INFORMATION
CMS postpones new payment policy for multiple diagnostic imaging procedures
It has been a longstanding policy under the Outpatient Payment Prospective System (OPPS) that there is a reduction in payment for multiple surgical procedures performed on the same patient in the same operative session. However, this policy has not been applied to multiple diagnostic imaging procedures performed on the same patient on the same day. Upon MedPAC’s recommendation to detect unbundled diagnostic imaging services and to reduce technical component payments because of efficiencies associated with these multiple imaging services using the same modality when they are performed on contiguous areas of the body in a single session, CMS...
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Article Overview
This article covers CMS’s consideration of how outpatient payment policy should address multiple diagnostic imaging procedures performed in the same session, including the agency’s use of claims analysis, input from MedPAC and APC-related review, and the decision to postpone implementation of a new reduction policy. It is relevant to hospital outpatient coding, OPPS reimbursement, and readers tracking federal payment policy changes affecting diagnostic imaging.
Why This Topic Matters
The discussion affects how hospitals and coding professionals understand evolving OPPS payment methodology for imaging services, especially when multiple procedures are reported on the same day. It also highlights the policy process CMS uses before changing payment structure for diagnostic imaging.
What You Will Learn
- Why CMS reviewed payment policy for multiple diagnostic imaging procedures
- How claims data and external recommendations influenced the policy discussion
- Why CMS decided to defer implementation and continue analysis
- What the article suggests about future outpatient payment revisions for imaging services
Who Should Read This
- Hospital outpatient coders
- Revenue cycle professionals
- Compliance staff
- Health information management professionals
- Medical coding educators
- Healthcare reimbursement analysts
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