Wiki Healthcare Business Monthly Article from Feb 2018

njense

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Hello,

I need help understanding the article titled "2018 OPPS Payments" on page 38. In particular the paragraph “Packaging Expansion Continues” in the article it states, “Physician offices are not eligible for the payment of a visit if drug administration services are provided.” I take this to mean that Medicare will no longer pay IM administration code 96372 with an E/M code.

The CMS NCCI edits effective Jan 1, 2018 do not reflect this edit. I also have not seen an email from Medicare confirming this packaging of services.

Can anybody clarify or confirm this?

Thank-You,
Nancy Jensen, CPC
 
This change really only applies to facility reimbursement under OPPS, which is a very different payment structure from physician reimbursement, and is to bring facility payment side to bring it into alignment with what occurs on the physician side.

In a physician office, CPT 99211 (the visit charge) is bundled to a drug administration (96372) and can't be unbundled with a modifier and this is what's being implemented for facilities with the new OPPS rules. Physicians can still bill an E&M service and unbundle it with a 25 modifier, as they have before, but that is for a Part B professional fee. But since facilities do not bill for professional fees, that situation would not apply.

I think the statement in the article is a little bit of an over-simplification of what they're doing because 'packaging' is not the same thing as 'bundling' - packaging refers to combining the prospective payment for both services into one payment rate. Packaging is not a payment methodology used by Part B and does not apply to physician services. But the bottom line is that this change does not affect independent physician offices, only facilities. Hope that helps some and isn't more confusing.
 
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