There are 1,747 procedures on the inpatient-only list for CY
2018. The inpatient-only list is found in Addendum E of the CY
2018 OPPS final rule.
Addendum D1 is the listing and description of OPPS payment
status indicators for C Y 2018. There were no changes to status
indicators for C Y 2018.
Comprehensive Ambulatory Payment Classification
In 2014, CMS developed Comprehensive Ambulatory Payment
Classifications (C-APC), which became effective on January 1,
2015. C-APCs were implemented to provide a single APC payment for services that are generally performed together in a
single encounter. There were no new C-APCs created for CY
2018 but CMS finalized a complexity adjustment converting
the existing Low-Dose Rate Prostate Brachytherapy Composite APC to a C-APC by assigning HCPCS code 55875 to C-APC
5375 (Level 5 Urology and Related Services). Note that in CY
2018 there are 61 procedure and surgical C-APCs and one observation C-APC.
Hospital Outpatient Quality Reporting Program Changes
There were several changes in the C Y 2018 final rule related to the
Hospital Outpatient Quality Reporting Program. One change under the final rule is that CMS has removed six measures from the
Hospital Quality Reporting Program for the 2020 payment (2018
reporting) determination and subsequent years.
The six measures that have been removed are:
OP-1: Median time to fibrinolysis
OP-4: Aspirin at arrival
OP-20: Door to diagnostic evaluation by a qualified medical professional
OP-21: Median time to pain management for long bone
OP-25: Safe surgery checklist use
OP-26: Hospital outpatient volume data on selected out-
patient surgical procedures
For 2018 reporting (2020 payment year), CMS is postponing
indefinitely the proposal for the survey-based measures that
are part of the Outpatient and Ambulatory Surgery Consumer
Assessment of Healthcare Providers and Systems.
More Changes to Review
The items discussed in this article are only some of the many
changes that were part of the CY 2018 OPPS final rule. Individu-
als should visit the CMS.gov website and read the full 282-page
document to have a complete understanding of all the nuances
of the CY 2018 OPPS. Any time there are changes or updates to
the coding systems, facilities should always check with their
non-Medicare providers to determine if their rules have been
updated as well. ¢
1. Nickels, Tom. “Statement on Final CY 2018 OPPS Rule.”
Press release. November 1, 2017. www.aha.org/presscen-
Centers for Medicare and Medicaid Services. “2018
NFRM OPPS Addenda.” www.cms.gov/apps/ama/
Centers for Medicare and Medicaid Services. “Hospital
Outpatient Prospective Payment – Notice of Final
Rulemaking (NFRM) with Comment Period.” www.cms.
Centers for Medicare and Medicaid Services. “Medicare Program:
Hospital Outpatient Prospective Payment and Ambulatory
Surgical Center Payment Systems and Quality Reporting
Programs.” Federal Register 82, no. 239 (December 14, 2017).
Gina Sanvik ( email@example.com) is a director of HIM practice excellence at AHIMA.
Quiz ID: Q1838903 | EXPIRATION DATE: MARCH 1, 2019
HIM Domain Area: Clinical Data Management
Article—“CY 2018 OPPS Update”
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on this Article Online at
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Any time there are changes or updates to the coding systems, facilities
should always check with their non-Medicare providers to determine if
their rules have been updated as well.