Submitting 2009 facility critical care claims
APCs Weekly Monitor, December 26, 2008
Want to receive articles like this one in your inbox? Subscribe to APCs Weekly Monitor!
Q. Can you comment on facility critical care and how to submit claims for 2009?
A. From the end of December 2007 through 2008, CMS’ position regarding facility claims and the submission of critical care services with CPT code 99291 (critical care, evaluation and management of the critically ill or critically injured patient, first 30-74 minutes) puzzled hospitals, FIs, and MACs. The question has been whether the hospital follows the CPT instructional guidelines within the critical care section of the CPT manual and those services which are part of the guidelines.
The 2009 OPPS final rule, below, clarifies CMS’ position, which in turn means sweeping operational challenges for hospitals:
Hospitals should separately report all HCPCS codes in accordance with correct coding principles, CPT code descriptions, and any additional CMS guidance, when available. Specifically with respect to CPT code 99291, hospitals must follow the CPT instructions related to reporting that CPT code. Any services that CPT indicates are included in the reporting of CPT code 99291 should not be billed separately by the hospital. In establishing payment rates for visits, CMS packages the costs of certain items and services separately reported by HCPCS codes into payment for visits according to the standard OPPS methodology for packaging costs.
Consistent with past input we have received from many hospitals, hospital associations, the APC Panel, and others, we will continue to utilize CPT codes for reporting services under the OPPS whenever possible to minimize hospitals’ reporting burden. If the AMA were to create facility-specific CPT codes for reporting visits provided in HOPDs, we would certainly consider such codes for OPPS use.
Want to receive articles like this one in your inbox? Subscribe to APCs Weekly Monitor!
Comments
0 comments on “Submitting 2009 facility critical care claims ”
Related Products
-
Modifier -59 Case Studies: Clarify Common Coding Confusion
Modifier -59 is a perennial problem area for outpatient coders. It shouldn’t be viewed as a way to guarantee payment but...
-
Outpatient Therapy Billing Challenges: Limit the Impact of Reduced Payments
During this 90-minute audio conference, you’ll learn how to adjust your practice to limit financial impact of payment...
-
Outpatient Bed Charge Capture: Billing for Common and Complex Cases
During this 90-minute audio conference, our expert speakers walk you through common and complex cases and explain compliant...
-
Billing No-Cost and Low-Cost Devices: Tips to Avoid the Audit Fast Track
During this 90-minute audio conference, our speakers will use a case study to demonstrate best practices to help you comply...
-
Observation Services: Assign Proper Level of Care to Prevent Denials
During this two-hour audio conference, our expert speaker reviews level of care regulations, addresses medical necessity...
Most Popular
- Articles
-
- HIPAA Q&A: Flu shot requirement for hospital employees
- HealthDataInsights posts new issues for medical necessity claims
- Q&A: Incidental disclosures and patient privacy
- New FAQ posted on storing laryngoscope blades
- Running an effective peer review committee meeting
- Sneak Peek: Effort underway to establish caseload benchmarks
- Tip: Perform your own internal investigation prior to government audit
- What does case-mix index mean to you?
- HIPAA 5010 deadline extended, but threat remains, says AMA
- HHS task force: Consider privacy, security with text messages
- E-mailed
-
- Running an effective peer review committee meeting
- HIPAA Q&A: Flu shot requirement for hospital employees
- What does case-mix index mean to you?
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- HHS task force: Consider privacy, security with text messages
- Tip: Correctly code bilateral pain management procedures
- Tip: Know the common bunionectomy procedure codes and how to use them
- Code changes should help ease the pain when coding for facet joint injections
- 2012 CPT code changes for ASCs: Shoulder and knee scopes and pain management
- COT basics to best
- Searched