CPT/HCPCS Hospital Outpatient Reporting Part II (February 2003)

Why This Topic Matters

OPPS reporting depends on selecting the correct code set and understanding how CMS assigns status indicators, APCs, and temporary codes. This article helps readers recognize the categories of guidance that drive hospital outpatient claim submission and keep pace with 2003 updates.

Article Sections

1. February 2003 pages 7-14

   Introductory coding update and overview of the article’s focus on Medicare hospital outpatient reporting under OPPS.

2. CPT Add-on Codes

   Discussion of CPT add-on code concepts and the general characteristics used to identify them in outpatient reporting.

3. Unlisted Procedure or Service

   Overview of reporting services or procedures that are not found in the standard CPT structure and how OPPS addresses them.

4. HCPCS Level II G Codes

   Explanation of temporary and permanent HCPCS G code use within Medicare outpatient reporting and why some G codes are created.

5. HCPCS Level II G Codes Representing Medicare-Specific Benefits

   Broad discussion of G codes tied to Medicare benefit or implementation timing issues.

6. Departure from CPT Intent and Usage

   Discussion of situations where HCPCS G codes are used to reflect Medicare policy differences from CPT usage.

7. New Technology (Not Currently Reportable by CPT)

   Coverage of temporary HCPCS coding used for emerging technology and related outpatient payment timing.

8. More Specific Delineation of a Service/Procedure

   General explanation of how CMS and CPT review G codes for possible transition or replacement in later CPT code sets.

9. CPT 2003 Changes Based on HCPCS Level II G Code Review

   Summary of 2003 code-set revisions associated with the G code review process and related outpatient reporting implications.

10. When to Report a HCPCS Level II Code Versus a CPT Level I Code

    General guidance on distinguishing between overlapping CPT and HCPCS Level II reporting in the OPPS environment.

11. ADDENDUM B. -- PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION CALENDAR YEAR 2003

    Excerpted 2003 status information and payment-related details for selected outpatient codes and APC assignments.

12. Code Conditions

    Definitions of CMS code-condition abbreviations used in final rule addenda for selected 2003 outpatient codes.

13. Related References

    Source and reference pointers for further OPPS coding and policy research.