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Vasospasm and POS

Leorah Posted Tue 21st of May, 2019 12:31:51 PM
Our patient came in for a follow up angiogram and ended up needing to have a verapamil infusion emergently. GHI is stating that 61650 (verapamil infusion) cannot be done in the outpatient setting, BUT THE patient was not admitted as an inpatient so obviously it can be done in the outpatient setting. Is there a rule about 61650 and the needed POS? Thanks
SuperCoder Answered Wed 22nd of May, 2019 08:51:39 AM

Thank you for your question.

CPT code 61650 have an APC Status indicator of C which means it should be done at an inpatient only. CMS (in the OPPS facility reimbursement rules) has payment restrictions on certain types of procedures that CMS has determined should only be done inpatient (codes with status indicator C), and so will not pay a facility if billed as outpatient.

Please check with your respective payer for any specific reimbursement guideline for the procedure performed.

 

Hope this Helps!

Leorah Posted Fri 24th of May, 2019 12:23:08 PM
Where on Supercoder are we able to see the APC Status indicator? Empire Blue Cross Blue Shield is now denying inpatient admission for 61624 and we are aware that the authorization for this procedure must also allow inpatient admission overnight,
SuperCoder Answered Mon 27th of May, 2019 06:07:04 AM

Thank you for your Question.

 

Super Coder shows APC status indicator data under OPPS Hospital Based tab of OPPS fee schedule. As these codes 61650 or 61624 are inpatient only procedure and these codes are not an ASC approved procedure hence there is no data available on Super coder for such codes for APC indicator. You can visit Appendix C on Super Coder for the list of inpatient procedure only codes.

We would recommend you contact the insurance company that denied this and find out what their policy is, and whether or not it's something you can appeal.

Hope this Helps!

Leorah Posted Mon 27th of May, 2019 15:25:18 PM
I am not sure where on Super Coder to find Appendix C and when I want to prove to the payer that this is an inpatient only procedure I need to quote CMS and unfortunately not Super Coder. Where can I tell the payer that this information is to be found on the CMS website or other documented location?
SuperCoder Answered Tue 28th of May, 2019 06:19:01 AM

Thank you for your Question!

On Super Coder home page Left navigation under Coding then tab CPT section Appendices tab you will find all the appendix. Here under Appendices tab Appendix C- Inpatient only procedure codes you can get list of all codes those are Inpatient only procedures.

We have provided undermentioned CMS link from where you can fetch all the procedure code list which have APC indicator C and are Inpatient Only procedures codes.

 

 

 

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1695-P.html

Hope this Helps!

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