OPPSPAYMENTPACKAGING--PACEMAKERPROCEDURES

Quest ion: We recent ly perform ed bot h a t em porary pacem aker and a perm anent pacem aker procedure during t he sam e out pat ient encount er (w it h a span of 2 days.) Medicare didn? t pay for t he t em porary pacem aker procedure. Can you offer guidance t o help us get paid for bot h procedures?An exam ple w ould be 33210, follow ed by 33208 on a subsequent day

Answ er: Actually, under Medicare?s Outpatient Prospective Payment System (OPPS), the hospital was paid for both procedures, although only CPT33208 carries the total reimbursement amount

Medicare?s OPPSpayment system calculates reimbursement for a claim according to the ?Status Indicator?of the HCPCScodes reported on the same outpatient claim, regardless of the date of service.Both HCPCS(33210 and 33208) are OPPSstatus J1 ? ?Hospital Part B Services Paid Through a Comprehensive APC?:

Under OPPS, only one Status J1 code will be paid, payment for all other lines will be ?packaged?to the primary (highest paying) J1 code on the same claim.When CMSsets the rate of reimbursement for a ?comprehensive APC?, the rate-setting process takes into consideration costs reported from the entire body of claims submitted by facilities nationwide for the same procedure.