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March 27, 2018


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Medical Coding News Archives

CMS Proposes Multiple Imaging Composite APCs

 
August 26, 2008:

The Centers for Medicare and Medicaid Services proposes changing the way multiple imaging procedures are paid to reflect and promote efficiencies in performing multiple imaging procedures during a single session.

The agency made the proposal after analyzing claims data in depth. For 2009, CMS proposes five multiple imaging composite ambulatory payment classifications (APCs):

  • APC 8004
    Ultrasound Composite
  • APC 8005
    CT and CTA without Contrast Composite
  • APC 8006
    CT and CTA with Contrast Composite
  • APC 8007
    MRI and MRA without Contrast Composite
  • APC 8008
    MRI and MRA with Contrast Composite

    The proposed median costs for these APCs was calculated using 2007 claims data by isolating “single session” claims with more than one imaging service within a family. The 2009 OPPS proposal calculates the composite APC payment amounts empirically from estimated costs on claims for multiple imaging services provided in a single session. This proposed composite methodology for multiple imaging services parallels the other composite APC payment methodologies.

    This proposed policy would provide one composite APC payment each time a hospital bills more than one procedure described by the HCPCS codes in one outpatient prospective payment system (OPPS) imaging family on a single date of service. If the hospital performs a procedure without contrast during the same session as at least one other procedure with contrast using the same imaging modality, the hospital would receive payment for the “with contrast” composite APC.

    A single imaging procedure, or imaging procedures reported with HCPCS codes assigned to different OPPS imaging families, would be paid according to the standard (sole service) imaging APC to which it is assigned in 2009. Hospitals would continue to use the same HCPCS codes to report imaging services, and the integrated outpatient code editor (IOCE) would determine when combinations of imaging procedures would qualify for composite APC payment or would map to standard APCs for payment. The proposed composite APCs have status indicators of S, signifying that payment for the APC would not be reduced when the same claim also lists other significant procedures.

    Regina Magnani, RHIT
    Clinical/Technical Editor

     

     
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