dwaldman
True Blue
I put this together to look at anticipated changes of the packaging of add on codes by Medicare for the hospital outpatient fee schedule in 2014 for common pain management procedures. Thought I would share it if interested, check it out.
2013 Oct Addendum B
62319 APC 203 $856.68
2014 Proposed Addendum B
62319 APC 207 $679.96
Difference: Lumbar Epidural Catheter Infusion/Bolus (more than single calendar day) goes down $177.00.
2013 Oct Addendum B
64479 APC 207 $565.75
64480 APC 206 $146.00 (50 percent reduction applied to listed amount)
Total__________$712.00
2014 Proposed Addendum B
64479 APC 207 $679.96
64480 Payment packaged N status indicator
Difference: One level goes up $114.00 Two levels goes down 32
64483 and 64484 fall under same APC and pricing as above.
2013 Oct Addendum B
64490 APC 207 $565.75
64491 APC 204 $91.00 (50 percent reduction applied to listed amount)
64492 APC 204 $91.00
Total------------748.00
2014 Proposed Addendum B
64490 APC 207 $679.96
64491 Packaged payment
64492 Packaged payment
Difference: One level goes up $114.00 Two level goes up $22.00 Three levels goes down 68
64493 64494 64495 falls under the same APC and pricing as above
2013 Oct Addendum B
64633 APC 207 $565.75
64634 APC 204 $91.00 (50 percent reduction applied)
64634 APC 204 $91.00
Total--------------$748.00
2014 Proposed Addendum B
64633 APC 203 $1558.30
64634 Packaged payment
64634 Packaged payment
Difference: One level goes up 1502.00 Two levels goes up 901.00 Three levels goes up 810.00
2013 Oct Addendum B
64635 APC 203 $856.68
64636 APC 207 $283.00
64636 APC 207 $283.00
Total-------------$1425.00
2014 Proposed Addendum B
64635 APC 203 $1558.30
64636 Packaged payment
64636 Packaged payment
Difference: One level goes up 702.00. Two levels goes up 418.00 Three levels goes up 133.00
http://www.cms.gov/Medicare/Medicar...P.html?DLPage=1&DLSort=2&DLSortDir=descending
Add-on codes describe procedures that are always performed in addition to a primary procedure. Add-on codes can be either CPT codes or Level II HCPCS codes. For example, the procedure described by CPT code 11001 is ‘‘Debridement of extensive eczematous or infected skin; each additional 10% of the body surface, or part thereof (list separately in addition to code for primary procedure).'' This code is used for additional debridement beyond that described by the primary procedure code. Currently, add-on codes are treated like other codes in the OPPS. Add-on codes typically received separate payment based on an APC assignment, and are typically assigned status indicator ‘‘T.'' Procedures described by add-on codes represent an extension or continuation of a primary procedure, which means that they are typically supportive,
dependent, or adjunctive to a primary surgical procedure. The parent code defines the purpose of the patient encounter and the add-on code typically describes additional incremental work, when the extent of the procedure encompasses a range rather than a single defined endpoint applicable to all patients. For example, add-on CPT code 11001 is used for each additional 10 percent of debridement. Therefore, according to longstanding OPPS packaging principles described above and the dependent nature and adjunctive characteristics of procedures described by add-on codes, we believe that such procedures should be packaged with the primary procedure. For CY 2014, we are proposing to unconditionally package all procedures described by add-on codes in the OPPS. There is an additional benefit to packaging add-on codes—more accurate OPPS payment for procedures described by add-on codes. Currently, calculating mean costs for procedures described by add-on codes is problematic in the OPPS because we cannot determine which costs on a claim are attributable to the primary procedure and which costs are attributable to the add-on procedure. Furthermore, because we use single claims and ‘‘pseudo'' single procedure claims for ratesetting, we generally must rely on incorrectly coded claims containing only the add-on code to calculate payment rates for add-on procedures. Claims containing only an add-on code are incorrectly coded because they should be reported with (or ‘‘added-on'') a primary procedure. Packaging the line item costs associated with an add-on code into the cost of the primary procedure will help address this ratesetting concern because the costs of the add-on code would be packaged into the primary procedure, and we would no longer have to calculate costs for add-on codes based on miscoded claims. In addition, packaging add-on codes would increase the number of single bills available for ratesetting for the primary procedures. We are revising the regulations at §419.2(b) to include the packaging of add-on codes. The specific add-on codes that we are proposing to be unconditionally packaged and assigned status indicator ‘‘N'' for CY 2014 are listed in Addendum P of this proposed rule, which is available via the Internet on the CMS Web site.
2013 Oct Addendum B
62319 APC 203 $856.68
2014 Proposed Addendum B
62319 APC 207 $679.96
Difference: Lumbar Epidural Catheter Infusion/Bolus (more than single calendar day) goes down $177.00.
2013 Oct Addendum B
64479 APC 207 $565.75
64480 APC 206 $146.00 (50 percent reduction applied to listed amount)
Total__________$712.00
2014 Proposed Addendum B
64479 APC 207 $679.96
64480 Payment packaged N status indicator
Difference: One level goes up $114.00 Two levels goes down 32
64483 and 64484 fall under same APC and pricing as above.
2013 Oct Addendum B
64490 APC 207 $565.75
64491 APC 204 $91.00 (50 percent reduction applied to listed amount)
64492 APC 204 $91.00
Total------------748.00
2014 Proposed Addendum B
64490 APC 207 $679.96
64491 Packaged payment
64492 Packaged payment
Difference: One level goes up $114.00 Two level goes up $22.00 Three levels goes down 68
64493 64494 64495 falls under the same APC and pricing as above
2013 Oct Addendum B
64633 APC 207 $565.75
64634 APC 204 $91.00 (50 percent reduction applied)
64634 APC 204 $91.00
Total--------------$748.00
2014 Proposed Addendum B
64633 APC 203 $1558.30
64634 Packaged payment
64634 Packaged payment
Difference: One level goes up 1502.00 Two levels goes up 901.00 Three levels goes up 810.00
2013 Oct Addendum B
64635 APC 203 $856.68
64636 APC 207 $283.00
64636 APC 207 $283.00
Total-------------$1425.00
2014 Proposed Addendum B
64635 APC 203 $1558.30
64636 Packaged payment
64636 Packaged payment
Difference: One level goes up 702.00. Two levels goes up 418.00 Three levels goes up 133.00
http://www.cms.gov/Medicare/Medicar...P.html?DLPage=1&DLSort=2&DLSortDir=descending
Add-on codes describe procedures that are always performed in addition to a primary procedure. Add-on codes can be either CPT codes or Level II HCPCS codes. For example, the procedure described by CPT code 11001 is ‘‘Debridement of extensive eczematous or infected skin; each additional 10% of the body surface, or part thereof (list separately in addition to code for primary procedure).'' This code is used for additional debridement beyond that described by the primary procedure code. Currently, add-on codes are treated like other codes in the OPPS. Add-on codes typically received separate payment based on an APC assignment, and are typically assigned status indicator ‘‘T.'' Procedures described by add-on codes represent an extension or continuation of a primary procedure, which means that they are typically supportive,
dependent, or adjunctive to a primary surgical procedure. The parent code defines the purpose of the patient encounter and the add-on code typically describes additional incremental work, when the extent of the procedure encompasses a range rather than a single defined endpoint applicable to all patients. For example, add-on CPT code 11001 is used for each additional 10 percent of debridement. Therefore, according to longstanding OPPS packaging principles described above and the dependent nature and adjunctive characteristics of procedures described by add-on codes, we believe that such procedures should be packaged with the primary procedure. For CY 2014, we are proposing to unconditionally package all procedures described by add-on codes in the OPPS. There is an additional benefit to packaging add-on codes—more accurate OPPS payment for procedures described by add-on codes. Currently, calculating mean costs for procedures described by add-on codes is problematic in the OPPS because we cannot determine which costs on a claim are attributable to the primary procedure and which costs are attributable to the add-on procedure. Furthermore, because we use single claims and ‘‘pseudo'' single procedure claims for ratesetting, we generally must rely on incorrectly coded claims containing only the add-on code to calculate payment rates for add-on procedures. Claims containing only an add-on code are incorrectly coded because they should be reported with (or ‘‘added-on'') a primary procedure. Packaging the line item costs associated with an add-on code into the cost of the primary procedure will help address this ratesetting concern because the costs of the add-on code would be packaged into the primary procedure, and we would no longer have to calculate costs for add-on codes based on miscoded claims. In addition, packaging add-on codes would increase the number of single bills available for ratesetting for the primary procedures. We are revising the regulations at §419.2(b) to include the packaging of add-on codes. The specific add-on codes that we are proposing to be unconditionally packaged and assigned status indicator ‘‘N'' for CY 2014 are listed in Addendum P of this proposed rule, which is available via the Internet on the CMS Web site.