July 2015 OPPS Modifier and Code Updates
Off-Campus, Offset, and Off-Kilter
The heat index is hovering around 100° this week, so it seems the hot, lazy days of summer are finally here. With the busy, hectic lives we live, I doubt anyone actually has time to be lazy, but the heat and humidity of summer can drag you down and make you feel off-kilter. The folks at CMS may be feeling a little “off” themselves these days with the latest OPPS update including descriptions for off-campus and offset.
The July 2015 OPPS Update includes a reminder about the use of the new PO modifier to identify services furnished at off-campus provider-based outpatient departments. Although the modifier is not required until January 1, 2016, it may be voluntarily reported in 2015. This modifier is to be reported with every HCPCS code for all outpatient hospital items and services furnished in an off-campus provider-based department of a hospital. This modifier should not be reported for remote locations of a hospital, satellite facilities of a hospital, or for services furnished in an emergency department. Definitions from 42 CFR 413.65(a) (2) and 412.22(h) applicable to this instruction include:
- Campus means the physical area immediately adjacent to the provider's main buildings, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings, and any other areas determined on an individual case basis, by the CMS regional office, to be part of the provider's campus.
- Remote location of a hospital means a facility or an organization that is either created by, or acquired by, a hospital that is a main provider for the purpose of furnishing inpatient hospital services under the name, ownership, and financial and administrative control of the main provider, in accordance with the provisions of this section.
- A satellite facility is a part of a hospital that provides inpatient services in a building also used by another hospital, or in one or more entire buildings located on the same campus as buildings used by another hospital.
CMS reversed their April 2015 decision concerning the device-offset for HCPCS code C2623, Catheter, transluminal angioplasty, drug-coated, non-laser. After further review, CMS has determined that a device-offset should not apply to claims billed with C2623. C2623 is to be billed with various peripheral transluminal balloon angioplasty codes that are assigned to APC 0083, APC 0229, or APC 0319. Providers may request an adjustment from their MAC for claims processed on or after April1, 2015 to which an offset was applied.
Other updates to codes, status indicators, etc. from the July 2015 OPPS transmittal are listed below:
As the MLN Matters Articles always say, “Make sure your billing staff are aware of these changes” or your claims may end up off-kilter.
Article by Debbie Rubio
This material was compiled to share information. MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.