AHA Coding Clinic® for HCPCS - 2004 Quarter 4
Required use of C-codes
In order to calculate the median costs for device-dependent APCs, CMS needs claims data for the devices that are required for use in the provision of services in these APCs. The coding of devices has been a challenge for hospitals since the implementation of the Outpatient Prospective Payment System (OPPS). In August 2000, new technology devices were coded separately using device-specific C-codes. Nine months later, Congress mandated that devices be rolled into categories and identified with C-codes. In 2002, CMS “folded-in” 75% of transitional pass-through payments into the base APC rates. In 2003, a number of devices on...
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Article Overview
This article covers CMS guidance on required use of device C-codes in the outpatient prospective payment system, including the background for device-dependent APC data collection, the shift from voluntary to required reporting, proposed and final rule activity, implementation timing, and the table of device codes referenced in the rulemaking. It is relevant to hospital outpatient coding staff, chargemaster teams, revenue cycle professionals, and others involved in OPPS claim preparation and device reporting. The article also discusses related operational issues such as claim edits, code-level reporting, and CMS’s review of comments on device coding policy.
Why This Topic Matters
Accurate device reporting affects outpatient claims processing and the data CMS uses to set payment rates for device-dependent services. The article is useful for organizations that need to understand the policy context, reporting expectations, and the device-code set referenced in the final rule.
Article Sections
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Background on device reporting under OPPS
Provides the policy background for CMS device reporting under the outpatient prospective payment system and explains why device claims data became important for payment setting.
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Proposed mandatory device coding
Summarizes CMS’s proposed approach to requiring device coding on claims and the broader goal of improving claims data for outpatient payment calculations.
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Comments and final rule implementation
Covers stakeholder feedback, the final rule’s effective date, and the planned timing for claim edit implementation and review.
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Additional CMS considerations
Describes related CMS considerations on future device coding refinements, review processes, and provider education.
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Table 20: Device Code Descriptors for Select Device-Dependent APCs
Presents the referenced device code listing associated with select device-dependent APCs in the final rule.
What You Will Learn
- The policy background for device coding in the outpatient prospective payment system
- How CMS described the move from voluntary to required device reporting
- The general implementation and review timeline discussed in the article
- What types of operational edits and claim-level considerations were addressed
- Which device code listings were referenced in the final rule
Who Should Read This
- Hospital outpatient coders
- Chargemaster and billing staff
- Revenue cycle and reimbursement professionals
- Compliance teams
- OPPS policy analysts
Codes Discussed
Modifiers Discussed
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