July 2008 Update of the Hospital
Outpatient Prospective Payment
System (HOPPS)
On June 19th, the Centers for Medicare & Medicaid Services
(CMS) issued Transmittal 1536. On January 1, 2008, CMS implemented
OCE edits which were part of the 2008 HOPPS Final
Rule that required a diagnostic radiopharmaceutical to be
present on the same claim as a nuclear medicine procedure.
However, since the April update, CMS has stated they have
received descriptions of clinical scenarios where a therapeutic
radiopharmaceutical or a brachytherapy source is provided to a
patient by a hospital and a nuclear medicine procedure follows,
without administration of a diagnostic radiopharmaceutical.
Therefore, effective July 2008, the HCPCS codes have been
added for all diagnostic radiopharmaceuticals, therapeutic
radiopharmaceuticals, and brachytherapy sources as appropriate
products that may be reported on a claim with a nuclear
medicine procedure. Claims containing a nuclear medicine procedure
reported with any of the HCPCS codes for diagnostic
radiopharmaceuticals, therapeutic radiopharmaceuticals, or
brachytherapy sources will not be returned to providers. CMS
also stated that this change is retroactive to January 1, 2008.
As part of the Transmittal, CMS corrected the long descriptors
for two Cardiac echocardiography C-codes, C8922 and C8924,
that were published incorrectly in Table 3 of the April 2008
update to the OPPS (Transmittal 1487, CR 5999, issued April 8,
2008). The correct descriptors for the eight C-codes for cardiac
echocardiography with contrast services are posted at the
following:
http://www.cms.hhs.gov/HCPCSReleaseCodeSets/02_HCPCS_Quarterly_Update.asp#TopOfPage
The Transmittal can be found by going to:
http://www.cms.hhs.gov/transmittals/downloads/R1536CP.pdf
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Summer 2008 Newsletter
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