Our coding experts answer your questions about how to determine the correct units for drugs, billing for fluoroscopy, therapy caps under OPPS, and payment for critical care and separately reported services
When the AMA revised the instructions for reporting ancillary services with critical care in 2011, facilities knew they wouldn't see an immediate increase in payment. CMS determines payment amounts through use of claims data from two years earlier, meaning the earliest facilities could expect additional reimbursement is 2013.
Our coding experts answer your questions about coding for hysteroscopy prior to ablation, appending modifier -59 for MRI and MRA, charging for venipunctures, therapy caps under OPPS, reporting limits for Provenge®, modifier -59 and infusion therapy, Reporting TEE pre- and post-operativley, coding for toxic metabolic encephalopathy
CMS is proposing two major changes as part of the 2013 OPPS proposed rule, released July 6. One has to do with how CMS proposes to calculate APC relative weights; the other addresses the reimbursement level for separately payable drugs and biologicals without pass-through status.
