Updates & Corrections

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Updates

Payment policy updates
Payment policy updates
Posting date Policy Area Description
April 25, 2012 Hospitals

Feb2012UpdatesAPR-DRG System Replacing AP-DRG System
The Department of Labor & Industries is planning to change its current DRG payment method based on All Patient Diagnostic Related Groups (AP-DRGs) to an All Patient Refined Diagnostic Related Groups (APR-DRGs) system. Implementation is currently scheduled for October 1, 2012.

 

March 27, 2012 Hospitals Swedish Hospital Issaquah has become an Acute Care Hospital provider for Labor and Industries. Feb2012UpdatesEffective dates for service beginning February 2012.
February 1, 2012 Hospitals Out of country Hospitals - Paid by an out of country POAC factor.
Effective February 1, 2012 the rate is 100%.
December 6, 2011 Pathology and Laboratory
Payment Policies

Correction to payment limits for Pathology and Laboratory Payment Policies.
The correct payment limits for the drug screen codes are:

Payment Limits

  • 80100, 80102 and G0431 are only payable to laboratories that don't require a CLIA certificate of waiver.
  • G0434 is limited to one unit per day per patient encounter regardless of the CLIA status of the laboratory.
November 23, 2011 Surgery Services Effective December 1, 2011, L&I will not cover the following codes based on a decision of the Health Technology Clinical Committee:

29914, Hip arthroscopy with femoroplasty.
29915, Hip arthroscopy with acetabuloplasty.

For more information, see the committee's decision at http://www.hta.hca.wa.gov/documents/findings_decision_fai.pdf
November 8, 2011 Reports and Forms

Report of Industrial Injury or Occupational Disease (State Fund)
Payment policy update

Effective January 1, 2012 a new web incentive will be available for ROAs submitted electronically.

The full payment policy is available here.
October 24, 2011 Nursing Homes Billing code change for the Nursing Home Fee Schedule. Group #9, Clinically Complex, will bill 8887H effective November 1, 2011 Oct2010UpdatesAdjustment Notice
August 19, 2011 Surgery Services Example 4 in the Endoscopy Payment Policies section is incorrect. This is the corrected example: Oct2010UpdatesEndoscopy Example 4
August 18, 2011 Medication Administration

The fees for the hyaluronic acid injections were inadvertently not updated in the payment policies section. The following table contains the correct fees.

HCPCS Code

Description

Maximum Fee

J7321

Hyalgan or Supartz inj

$140.40

J7323

Euflexxa, inj

$203.81

J7324

Orthovisc, inj

$270.00

J7325

Synvisc or Synvisc-1, per mg

$ 17.98
June 1, 2011 Reports and Forms

New payment policy for Report of Accident and Provider's Initial Report (billing code 1040M).

Research shows that when work related conditions or injuries are reported promptly, worker outcomes improve.

Effective July 1, 2011, to encourage prompt reporting, the insurer will pay for the Report of Accident or Provider's Initial Report (billing code 1040M) on a graduated scale based on when the insurer receives the 1040M following the first treatment date. If 1040M is received:

  • Within 5 business days after the first treatment date, the maximum fee is $37.84 (no payment reduction);
  • 6-8 business days after the first treatment date, the maximum fee is $27.84;
  • 9 or more business days after the first treatment date, the maximum fee is $17.84.

Does this policy apply to self-insured employers? Yes.

The full payment policy is available here
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Fee schedules updates
Fee schedule updates
Posting date Description Updated version
March 22, 2012 New HCPCS Codes, effective April 1, 2012 Oct2010UpdatesNew HCPCS Codes, effective April 1, 2012
December 15, 2011 New and end dated billing codes for 2012

Oct2010UpdatesAdditional CPT & HCPCS codes effective January 1, 2012
Oct2010UpdatesComma Delimited file of Additional CPT & HCPCS codes effective January 1, 2012
Oct2010UpdatesCPT and HCPCS codes invalid after December 31, 2011

December 9, 2011 January 2012 ASC Fee Schedule updates - additions and deletions Oct2010UpdatesJanuary 2012 ASC Fee Schedule updates
October 24, 2011 Billing code change for the Nursing Home Fee Schedule. Group #9, Clinically Complex, will bill 8887H effective November 1, 2011 Oct2010UpdatesFee Schedule Adjustment Notice
September 21, 2011 New HCPCS codes effective October 1, 2011 Oct2010UpdatesNew HCPCS codes effective October 1, 2011
July 25, 2011 The department is updating the fees for naturopathic physicians retroactively to July 1, 2011. Oct2010UpdatesNaturopathic Physician Fee Schedule Update
June 10, 2011 Additional CPT® and HCPCS codes effective July 1, 2011 Oct2010UpdatesAdditional CPT and HCPCS codes effective July 1, 2011
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Corrections

Payment policies corrections
Payment policy corrections
Posting date Page(s) Description
   

None at this time...

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Fee schedule corrections
Fee schedules corrections
Posting date Description Updated version
 

None at this time...