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APC Advisory Panel Meeting In Brief

This article was originally published in The Gray Sheet

Executive Summary

Device-coded claims for brachytherapy: CMS should re-analyze prostate brachytherapy claims data using only claims that include a C-code - indicating that a brachytherapy device was used in the procedure - before issuing the 2006 hospital outpatient prospective payment system final rule, the agency's Ambulatory Payment Classification advisory panel suggested Aug. 18 in Baltimore. Health Policy Solutions President Wendy Smith Fuss, who represents the Coalition for the Advancement of Brachytherapy, said that the proposed payment for APC 651 (prostate brachytherapy) is $718 - a 42.6% decline in payment from 2005. She contended that the majority of the claims used to base payment are miscoded and do not adequately represent the costs associated with the procedure. Payment rates based on the 181 "correctly-coded" claims would decrease the payment by only 20%, Smith Fuss said...
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