Results 1 to 4 of 4

CMS groupers

  1. #1
    Default CMS groupers
    Medical Coding Books
    Ok, I'm blown away by this one but maybe someone can shed light on it for me.

    I have a commercial payer that has a contract based on CMS groupers which haven't been used since 2007 but we continue to use the same groupers from 2007 until a new contract can be negociated. But there is a new code in 2011 which obviously would not be grouped because it was not a code in 2007. They paid it at a grouper 3 rate with is not a default grouper for this payer. I called and they said it was based on CMS groupers which this code is listed under grouper 3. I explained that it's a new code and no grouper assignment so should be default. They said that CMS continues to assign groupers. Well, now let me back up. I understand that Medicare changed from 10 groupers to one hundred-something groupers (if I remember correctly). Anyway, I'm unable to find the grouper listing now.

    Can anyone direct me to the CMS groupers?

  2. Default OPPS APC groups 2011

    Addendum B updates

    January 2011

    What is the CPT? Maybe I can help you follow the insurance company's logic. Why are they using a 2007 list?
    Last edited by blipps; 07-05-2011 at 05:23 PM. Reason: additional comments

  3. #3
    I don't know why they're using 2007 but I wish we could get an updated contract so we don't had to deal with all this bologna.

    I reviewed the list and I guess I don't know how to read it.

    I would love some help. It's CPT code 31296.

    Thank you!

  4. Default 31296
    These procedure codes are new in 2011 (31295, 96 & 97). In the 2011 APC grouper they fall into the same APC as CPTs 31239, 31254, 31255, 31256, 31267, 31276, 31287, 31288, 31292, 31293, 31294. You should be able to compare what these codes reimburse and it should be the same for the balloon procedures.

    Good Luck!

Similar Threads

  1. Cms
    By torihamill in forum Compliance General Discussion
    Replies: 2
    Last Post: 03-13-2015, 12:58 PM
  2. Cms
    By JDizon in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 04-02-2014, 05:56 PM
  3. Cms - Is anyone else having difficulties
    By slc112071 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 01-25-2010, 10:13 AM
  4. ASC groupers
    By den71ice in forum Outpatient Facilities
    Replies: 0
    Last Post: 09-02-2009, 03:27 PM
  5. Cms - Does anyone know for sure if CMS requests
    By karilynn in forum Medical Coding General Discussion
    Replies: 10
    Last Post: 12-05-2007, 04:34 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.