OIG calls for expanding use of claim codes for certain replacement devices

The Centers for Medicare & Medicaid Services should continue to work with national standards body X12 to include the new unique device identifier on its next version of health care claims forms, the Department of Health and Human Services’ Office of Inspector General advised yesterday. OIG also recommended that CMS require hospitals to use condition code 49 or 50 to report all device replacement procedures resulting from a recall or premature failure, which it said would help reduce Medicare costs by identifying poorly performing devices more quickly. Current claim forms include only information about the procedure performed and a field for reporting device failures and recalls when the manufacturer provides at least a 50% credit on the cost of the device. In the report, CMS said it is considering the first recommendation and concurs with the second “in cases where payment is impacted.”