Panel Advises CMS to Reduce Supervision Level for 28 Outpatient Services

After meeting for two days, Aug. 27-28, the Centers for Medicare & Medicaid Services’ (CMS) Advisory Panel on Hospital Outpatient Payment offered up its recommendation to reduce the supervision level for 28 outpatient services.

The panel is recommending CMS reduce the supervision level from direct to general for the following services:

Code	Descriptor
G0008	Administration of influenza virus vaccine
G0009	Administration of pneumococcal vaccine
G0010	Administration of hepatitis b vaccine
G0127	Trimming of dystrophic nails, any number
G0379	Direct admission of patient for hospital observation care
G9141	Influenza a (h1n1) immunization administration (includes the physician counseling the patient/family)
11719	Trimming of nondystrophic nails, any number
29580	Strapping; Unna boot
29581	Application of multi-layer compression system; leg (below knee), including ankle and foot
36000	Introduction of needle or intracatheter, vein
36591	Collection of blood specimen from a completely implantable venous access device
36592	Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified
51700	Bladder irrigation, simple, lavage and/or instillation
51702	Insertion of temporary indwelling bladder catheter; simple (eg, Foley)
51705	Change of cystostomy tube; simple
51798	Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging
96360	Intravenous infusion, hydration; initial, 31 minutes to 1 hour
+96361	Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)
96365	Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour
+96366	Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)
+96367	Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition to code for primary procedure)
+96368	Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure)
96372	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular
96374	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug
+96375	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure)
+96376	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provide in a facility (List separately in addition to code for primary procedure)
96521	Refilling and maintenance of portable pump
96523	Irrigation of implanted venous access device for drug delivery systems

If CMS takes the panel’s advice, this would mean the above services could be performed under direction of a physician or non-physician practitioner in absence of his or her physical presence.
The panel also recommends CMS:

Move G0379 Direct admission of patient for hospital observation care from ambulatory payment classification (APC) 0604 to APC 0608.
Place 0278T Transcutaneous electrical modulation pain reprocessing (eg, scrambler therapy), each treatment session (includes placement of electrodes) in APC 0218 for 2013.
Place 77424 Intraoperative radiation treatment delivery, x-ray, single treatment session and 77425 Intraoperative radiation treatment delivery, electrons, single treatment session in APC 0313.
Remove 22856 Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection), single interspace, cervical from the inpatient-only procedures list.
Assign 31629 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i) and 31634 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, with assessment of air leak, with administration of occlusive substance (eg, fibrin glue), if performed to APC 0415.
Assign 0242T Gastrointestinal tract transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report to APC 0142.

See the report for a complete account of the panel’s meeting and recommendations. CMS’ preliminary decisions on these recommendations will be posted to the panel’s website with a 30-day comment period to follow.