AMA Clinical Examples in Radiology - 2011 Bulletin 2
Hospital Outpatient Prospective Payment System 2012 Final Rule
Hospital Outpatient Prospective Payment System 2012 Final Rule The Centers for Medicare and Medicaid Services (CMS) finalized their proposal to create new Ambulatory Payment Classifications (APCs) for combined computed tomography (CT) of the abdomen and pelvis CPT codes. CPT code 74176 (Computed tomography, abdomen and pelvis; without contrast material) is assigned to APC 0331 (Combined Abdominal and Pelvis CT Without Contrast) with a payment rate of $405.60; and CPT codes 74177 (Computed tomography, abdomen and pelvis; with contrast material) and 74178 (Computed tomography, abdomen and pelvis; without contrast in one or both body regions, followed by contrast material(s)...
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Article Overview
This article reviews a CMS final rule affecting the Hospital Outpatient Prospective Payment System for 2012, with emphasis on newly bundled imaging-related services and how outpatient payment updates are handled. It is relevant to hospital outpatient coders, radiology billing staff, compliance teams, and reimbursement professionals who need to understand APC changes, quarterly update processes, and CMS guidance on charge setting for combined services. The discussion also references stakeholder input from specialty societies and the broader framework for CPT and HCPCS Level II updates affecting OPPS.
Why This Topic Matters
Changes in OPPS rules can affect hospital reimbursement, charge capture, and reporting practices for outpatient services, especially when previously separate services are combined into single reported codes. Understanding the final rule helps organizations monitor payment classification updates and related CMS instructions.
What You Will Learn
- How CMS’s 2012 outpatient prospective payment final rule affected bundled imaging services
- How APC assignment and outpatient payment updates are addressed in the rule
- How quarterly update change requests fit into the OPPS update process
- Which organizations participated in or commented on the rulemaking discussion
Who Should Read This
- Hospital outpatient coders
- Radiology billing and reimbursement staff
- Compliance teams
- Revenue cycle professionals
- Medical coding educators
- Healthcare administrators
Codes Discussed
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