Healthcare News: CMS adds new modifier -PD

CMS added modifier -PD (diagnostic or related nondiagnostic item or service provided in a wholly owned or wholly operated entity to a patient who is admitted as an inpatient within three days or one day) to the Integrates Outpatient Code Editor ( I/OCE )as part of the January updates detailed in Transmittal 2370.

Consider the following scenario: A hospital wholly owns or operates a clinic or an ambulatory service center (ASC) and a patient receives services there. If the patient is admitted to the hospital within three days, those services provided by the other entity must be included in the inpatient stay.

A problem arises because the clinic or ASC may be wholly owned but not provider-based. Provider-based clinics bill through the hospital and the information and management systems are tied together. A clinic or ASC that is not provider-based is freestanding and has its own management and billing practices. The freestanding clinic or ASC submits bills on its own and has its own information systems.

Because the freestanding facility doesn’t share information systems with the hospital, the hospital may not know when the three-day rule applies unless the patient mentions the prior visit.

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