Health Information Management

Tip: Understand Q status indicators

APCs Insider, September 18, 2009

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Under the 2009 OPPS final rule, bundling is now subdivided into status indicators Q1, Q2, and Q3.
  • Status indicator Q1: STVX-packaged codes. Addendum B of the final 2009 OPPS final rule displays APC assignments when services are separately payable. Packaged APC payment, if billed on the same date of service as a HCPCS code, is assigned status indicator S, T, V, or X. In all other circumstances, payment is made through a separate APC payment.
  • Status indicator Q2: T-packaged codes. Per Addendum D1 of the 2009 OPPS final rule, T-Packaged Codes, the provider receives a packaged APC payment if it bills a code with status indicator Q2 on the same date of service as a HCPCS code with a T status indicator. Q2 codes are only packaged with other T status indicators; otherwise, they are separately payable.
  • Status indicator Q3: Codes that may be paid through a composite APC. Addendum M of the 2009 OPPS final rule details codes that may be paid through a composite APC. When HCPCS codes that meet the criteria for payment of the composite APC are billed on the same date of service, CMS makes a single payment for all of the codes as a whole, rather than paying for each code.

This tip was adapted from the article “Concepts review: Sort out packaged versus bundled services” in the September issue of Briefings on APCs.

 



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