AHA Coding Clinic® for HCPCS - 2010 Issue 2
Reporting Implantable Devices
Certain devices, drugs/biologicals and other items that may be utilized in conjunction with outpatient procedures are typically reported under the hospital outpatient prospective payment system (OPPS) with HCPCS C-codes. These HCPCS C-codes capture the use of certain products/devices utilized during a surgical procedure, such as, a balloon catheter or a non coronary stent. It is important to note that HCPCS C-codes may not exist for every device. For additional information regarding the HCPCS device codes go to: http://www.cms.hhs.gov/HospitalOutpatientPPS/02_device_procedure.asp#TopOfPage Hospitals are encouraged to report all appropriate HCPCS C-codes regardless of payment status. Although, HCPCS C-codes were...
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Article Overview
This article reviews hospital outpatient reporting for implantable devices, biologicals used as implants, and other items associated with surgical procedures. It is aimed at hospital outpatient coders and reimbursement staff who need to understand the general scope of HCPCS device reporting, when device category codes may apply, and how certain products are discussed in the outpatient setting. The article also addresses the role of CMS and notes that payer recognition and device-code availability can vary.
Why This Topic Matters
Accurate outpatient device reporting affects charge capture, claim submission, and payer processing. Understanding the scope of HCPCS device coding helps hospitals identify when a product may be reported and when careful review of code language is needed.
Article Sections
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HCPCS device reporting in hospital outpatient procedures
Introduces hospital outpatient reporting for devices, drugs/biologicals, and other items used with procedures. Discusses the broader role of HCPCS device category codes and the involvement of CMS.
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Implantable use of biologicals and connective tissue products
Describes situations in which biologicals may be used as implantable items during surgery. Covers the general relationship between the product used and the device code reported.
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Reviewing device code descriptors
Explains the importance of comparing the product to the code language and related definitions before selecting a device code. Emphasizes that broad descriptors may encompass multiple items.
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Example involving soft-tissue repair products
Presents a question-and-answer discussion about reporting certain products used in outpatient soft-tissue repair. The section focuses on how the article frames the example in relation to HCPCS device reporting.
What You Will Learn
- How hospital outpatient device reporting is generally described in relation to HCPCS.
- When implantable or implant-like products are discussed as part of outpatient surgical procedures.
- Why code wording and definitions matter when evaluating device reporting options.
- How the article frames a specific soft-tissue repair product example in the outpatient setting.
Who Should Read This
- Hospital outpatient coders
- CDM and charge capture staff
- Revenue integrity teams
- Billing and reimbursement professionals
- Coding educators and auditors
Codes Discussed
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