Federal Register, Volume 75, Number 226, November 24, 2010, Pages 71519-72652 Page: 71,866
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71866 Federal Register/Vol. 75, No. 226/Wednesday, November 24, 2010/Rules and Regulations
guidelines and definition, they cannot
be appropriately reported. Therefore, for
CY 2011, we proposed to continue our
established policy of making packaged
payment for CPT code 96368 and CPT
code 96376, and we proposed to assign
them a status indicator of "N."
Comment: Commenters objected to
CMS' proposal to package payment for
CPT codes 96376 and 96368 into
payment for the services with which
they are furnished. The commenters
believed that the resources associated
with CPT code 96376 are similar to
those associated with CPT code 96374
(Therapeutic, prophylactic, or
diagnostic injection (specify substance
or drug); intravenous push, single or
initial substance/drug) (status indicator
"S"). They also believed that while the
resources associated with CPT code
96368 somewhat resemble the resources
associated with CPT code 96366
(Intravenous infusion, for therapy,
prophylaxis, or diagnosis (specify
substance or drug); each additional hour
(List separately in addition to code for
primary procedure) (status indicator
"S"), they are more similar to the
services described by CPT code 96375
(Therapeutic, prophylactic, or
diagnostic injection (specify substance
or drug); each additional sequential
intravenous push of a new substance/
drug (List separately in addition to code
for primary procedure) (status indicator
"S"). The commenters believed that the
fact that CPT codes 96376 and 96368 are
add-on codes does not preclude them
from being separately paid.
Several commenters disagreed with
CMS' statement that these services have
been packaged since the inception of the
OPPS. They stated that hospitals
formerly used a single CPT code for
reporting IV push administrations, CPT
code 90784. They further stated that this
code was reported and paid separately
for each and every IV push of either the
same or different medications. The
commenters indicated that when the
CPT coding system changed, the
payment for the "initial" successor CPT
code (90774 [now 96374]) remained
virtually identical to the rate for the
previous code. Similarly, they indicated
that services now reported with CPT
code 96368 were historically reported
under CPT codes 90780 and 90781 and
received separate payment.
Response: As we discussed in the CY
2008 OPPS/ASC final rule with
comment period (72 FR 66787 through
66788) and in the CY 2009 OPPS/ASC
final rule with comment period (73 FR
68674), in deciding whether to package
a service or pay for it separately, we
consider a variety of factors, includingwhether the service is normally
provided separately or in conjunction
with other services; how likely it is for
the costs of the packaged code to be
appropriately mapped to the separately
payable codes with which it was
performed; and whether the expected
cost of the service is relatively low. CPT
codes 96376 and 96368, by definition,
are always provided in association with
other drug administration services and
the costs of these services are highly
likely to be mapped to the separately
paid codes with which they are
performed and reported. For these
reasons, we continue to believe that
they are most appropriately packaged
under the OPPS. Therefore, we are not
accepting the APC Panel's
recommendation to pay them
separately.
Furthermore, we do not agree with the
commenters that the services described
by CPT code 96376 are similar to those
described by CPT code 96374. CPT code
96374 is an initial intravenous push
code, and, per CPT instructions, special
billing guidelines apply. Commonly,
this service requires the initial
establishment of intravenous access in a
patient, a resource-intensive task
performed by hospital staff using special
supplies. In contrast, CPT code 96376 is
an add-on code and is reported for each
additional sequential intravenous push
of the same substance/drug. In the case
of this sequential service, the patient
already has established intravenous
access, so we would expect the service
to require fewer hospital resources. In
addition, we do not agree with
commenters that the services described
by CPT code 96368 are similar to those
described by CPT code 96375. CPT code
96368 describes a concurrent
intravenous infusion while CPT code
96375 describes a sequential
intravenous push, and we would expect
these services to require different
hospital resources because the services
require different medical supplies,
require different nursing skills, and
require different amounts of staff time.
With regard to the comment that the
predecessor codes were separately
payable until CY 2008 under the OPPS,
we acknowledge that CPT code 90784
(Therapeutic, prophylactic or diagnostic
injection (specify material injected;
intravenous) was separately paid from
the inception of the OPPS until its
deletion, which was effective December
31, 2005, and might have been reported
for an additional sequential intravenous
push of the same substance, although
the code was not defined as being for an
additional sequential push. Similarly,
CPT code C8952 (Therapeutic,
prophylactic or diagnostic injection;intravenous push of each new
substance/drug), which was effective
January 1, 2006, and was deleted
effective December 31, 2006, also was
separately paid during the period that it
was effective and might also have been
reported for an additional sequential
intravenous push of the same substance,
although the code was not defined as
being for an additional sequential push.
CPT code 90776 (Therapeutic,
prophylactic or diagnostic injection
(specify substance or drug); each
additional sequential intravenous push
of the same substance/drug provided in
a facility (list separately in addition to
code for primary procedure)), which
was effective January 1, 2008, and
deleted effective December 31, 2008, is
the first code to specify that the service
is an additional sequential intravenous
push of the same substance/drug and
CPT code 90776 was packaged. Hence,
before the creation of CPT code 90776,
no code existed to specifically report an
additional sequential intravenous push
of the same substance; therefore, when
the incidental service was furnished,
there was no separate payment
specifically for this service. We believe
that hospital charges for the separately
payable codes for the initial
administration would have included a
charge for this service, and therefore,
the payment for it would have been
packaged into payment for the
separately paid code for the initial
administration service. However, we
acknowledge that it is possible that
hospitals reported the service using
separately paid codes that were not
defined to be an additional sequential
intravenous push of the same substance,
in which case we would have paid for
the service under the code that was
reported. When CPT code 96376, which
replaces CPT code 90776, was created
effective January 1, 2009, we assigned it
the packaged status of its predecessor
code, CPT code 90776. For the reasons
we articulate above, we disagree with
the commenter that predecessor codes
were separately payable and continue to
believe that we should continue our
policy of packaging the payment for the
service reported by this code.
With respect to CPT code 96368, we
disagree with the commenters that the
service has been paid separately since
the inception of the OPPS. CPT code
96368 was made effective January 1,
2009, and for CYs 2009 and 2010, we
assigned this code to status indicator
"N" to indicate that it is a packaged code
under the OPPS. Prior to 2009, CPT
code 96368 was described by its
predecessor CPT code 90768
((Intravenous infusion, for therapy,prophylaxis, or diagnosis (specify
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United States. Office of the Federal Register. Federal Register, Volume 75, Number 226, November 24, 2010, Pages 71519-72652, periodical, November 24, 2010; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/metadc52807/m1/355/: accessed May 5, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.