AHA Coding Clinic® for HCPCS - 2003 Issue 1; FOR your INFORMATION

CMS creates a new modifier

The Centers for Medicare & Medicaid Services (CMS) recently added a new modifier to the list of reportable modifiers under the outpatient prospective payment system (OPPS). Modifier –CA, Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission, became effective January 1, 2003. In order to receive payment for services billed with modifier –CA hospitals are instructed by CMS that all of the following conditions must be met: a. The status of the patient is outpatient; b. The patient has an emergent, life-threatening condition; c. A procedure on the...

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