AHA Coding Clinic® for HCPCS - 2007 Quarter 1; FOR your INFORMATION
Device editing
Since April 2005, CMS has had in place edits which require that if a hospital bills certain procedure codes that require a device, the claim must contain an appropriate device or it will be returned to be corrected under OCE edit 71 with the message: “Claim lacks required device code.” For example, if the hospital bills the HCPCS code G0300 for insertion of an ICD and leads, the hospital must also bill a device code for an ICD. The applicable table can be found at www.cms.hhs.gov/HospitalPPS/ under “January 2007 Procedure to Device Edits...
Subscribe or sign in to view the full article.
Article Overview
This article covers CMS hospital billing edits that connect certain procedures with required devices and certain devices with related procedures. It explains the broader purpose of these edits, how the edit messages were updated, and why CMS later separated the logic into distinct edit categories. The content is relevant for hospital coders, chargemaster staff, and revenue cycle teams reviewing outpatient claims and CMS edit tables.
Why This Topic Matters
These edits can cause claims to be returned for correction when the billed procedure and device information do not align with CMS edit requirements. Understanding the distinction between the edit types helps hospitals review returned claims more efficiently and work from the correct CMS table.
Article Sections
-
Procedure-to-device edits
This section introduces CMS edits that link certain hospital procedure claims with required device reporting and describes the related claim return workflow.
-
Device-to-procedure edits
This section covers the newer CMS edit category involving device reporting and the related procedure information expected on hospital claims.
-
Separating edit 71 and edit 77
This section explains CMS’s decision to distinguish two edit categories and notes the related claim message changes used to reduce confusion.
What You Will Learn
- How CMS hospital claim edits connect procedures and devices
- Why certain outpatient claims may be returned for correction
- How CMS distinguishes different device-related edit categories
- Which CMS edit tables are used to review returned claims
Who Should Read This
- Hospital coders
- Outpatient revenue cycle staff
- Chargemaster personnel
- Claims edit reviewers
- Healthcare billing professionals
Codes Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com