2007 OPPS Final Rule

2007 CPT/HCPCS Level II Changes

Below are the 2007 CPT/HCPCS changes that will affect ED professional and facility coding on January 1, 2007. Chargemaster changes can be made at any time due to the “effective date” functionality in E/Code. This information can significantly impact revenue opportunities in 2007. Discontinued 2006 codes will not be reimbursed after December 31, 2006.

For facility coding, the majority of Medicare HCPCS Level II “C” infusion/injection infusion codes have been deleted. OPPS has adopted the CPT infusion/injection codes for 2007 and will pay separately for these codes (new for 2007). The exception to this is code 90768, concurrent infusion, which will be a packaged procedure, status indicator N, and therefore not separately payable. This change will eliminate the multiple cross-walking issues which occurred between the two sets of codes used in 2006. After January 1 2007 if the deleted HCPCS Level II “C” infusion codes listed below are reported they will not be reimbursed.

Professional Changes 2007

CPT

There are no 2007 CPT code additions or deletions that will effect ED professional coding.

Revised Language for CPT codes 25600 and 25605

Previous Language:

• Closed treatment of distal radial fracture (eg. Colles or Smith type) or epiphyseal separation, with or without fracture of ulnar styloid, without manipulation

New Language:

• Closed treatment of distal radial fracture (eg. Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation

HCPCS Level II

• G0168 -Wound Closure with Tissue Adhesive only

For Medicare patients, you must report G0168 ( Wound closure utilizing tissue adhesive[s] only ) for a wound closure with tissue adhesive only. For Non-Medicare patients the appropriate CPT code is reported.

Please add G0168-Wound Closure with Tissue Adhesive to your Professional CDM if it is not currently available.

Facility Changes 2007

Deletions HCPCS Level II IV Infusion/Injection Codes

*Code C8957 Prolonged IV inf, req pump has not been deleted for 2007 as there is no corresponding CPT code to represent this service

Additions CPT IV Infusion/Injection Codes

Please add the following CPT IV/ Infusion Codes to your Facility CDM, if not already present.

90760 Hydration IV Infusion, initial, up to 1 hour

— 90761 Hydration IV infusion, each add’l. hour*

90765 Therapeutic/prophylactic /diagnostic IV infusion; initial, up to 1 hour

— 90766 each add’l. hour*

— 90767 additional sequential/subsequent infusion, up to 1 hour

— 90768 concurrent infusion**

90774 IV push, single or initial substance/drug

— 90775 each add’l sequential IV push, new drug/substance

* CPT has deleted previous language for codes 90761 and 90766 which stated “up to 8 hours”

** Although CMS will recognize code 90768, there will be no separate payment under the OPPS.

Additions HCPCS Level II Codes for facilities with Type B Emergency Departments

For those clients meeting the following CMS clarification of Type B Emergency Departments the following codes should be added to your CDM

Where a hospital maintains a separately identifiable area or part of a facility which does not operate on the same schedule (24/7) as its emergency department, the area would not be considered an integral part of the ED that operates 24 hours a day for the purpose of determining its ED type for reporting emergency visits. Instead, the facility or area would be evaluated separately to determine if it is a type A or type B ED or a clinic. We would expect the hospital to evaluate services in those areas and bill accordingly. In general, it is not appropriate to consider a satellite ED or an area of the ED as if it were available 24 hours a day simply because the main ED is available 24 hours. It may be appropriate for a Type A ED to “carve out” portions of the emergency department that are not available 24 hours a day, where visits would be more appropriately billed with type B ED codes. Source 2007 OPPS Final Rule

For those clients licensed or designated by the state or local government authority authorized to do so or as verified by the American College of Surgeons (ACS) as designated Trauma Center Levels (I, II, III, IV, Other). A new HCPCS code Trauma Response associated with Critical Care, G0390 has been established and will be paid separately under OPPS.

Please add code G0390 to your facility CDM if you are a designated Trauma Center and utilize Trauma Team Activation.