AAPC: Prepare Now for Modifier PD

CMS is expanding its “three-day payment window” for outpatient services provided within 72 hours of an inpatient admission, according to an AAPC report written by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CHCC, CENTC.

As of July 1, 2012, the payment window will apply to diagnostic and non-diagnostic services. Medicare will pay a reduced fee for physicians’ services that are clinically related to an inpatient admission, occur within 72 hours of the admission and are furnished by a physician practice wholly-owned or wholly-operated by a hospital. The rule applies whether the inpatient and outpatient diagnoses codes are the same or different.

The three-day payment window does not apply to rural healthcare or federally qualified healthcare centers. Also, when the decision for surgery is made within 72 hours prior to the surgery, physician services do not receive payment based on non-facility fees.

New HCPCS Level II modifier PD should be appended to identify claims for related services provided within 72 hours of an inpatient admission.

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