July 1 projected effective date for drug-eluting stent codes

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May 23, 2003
Vol. 4, No. 20

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THE MONITOR'S ADVISORY BOARD

Keith Siddel,
MBA, PhD (c),
president, CEO
HRM, Hospital Resource Management

Cheryl D'Amato,
RHIT, CCS,
director health information management
HSS, Inc.

Julie Downey,
CPC, CPC-H,
ambulatory coding coordinator, HIM
University Colorado Hospital

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Julia R. Palmer
MBA, RHIA, CCS,
president
Health Information Management Division of HRM

Valerie Rinkle, MPA,
revenue cycle director
Asante Health System

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July 1 projected effective date for drug-eluting stent codes

The new temporary HCPCS G-codes for drug-eluting stents may go into effect on July 1, 2003, Joan Sanow of CMS told participants at the May 6 Hospital Open Door Forum held in Washington, DC.

The effective date will most likely be published in a program memorandum before the July 1 date, says Diane R. Jepsky, RN, MHA, LNC, executive vice president of coding and compliance at CodeCorrect, Inc.Yakima, WA. CodeCorrect staff attended the Open Door Forum.

For drug-eluting stent procedures performed from April 24, 2003 through June 30, 2003, report the intracoronary stent insertion CPT codes 92980 and 92981 per the Open Door Forum instructions, Jepsky says. Both codes compact to APC 0104 for an approximate payment of $3992.09.

The FDA approved the Cypher Sirolimus-Eluting Coronary Stent (Cypher stent) made by Cordis Corporation on April 24, 2003.

Special Report for our Monitor readers only!

Next week, look for our exclusive special report on coding chemotherapy infusions and a leucovorin infusions in an outpatient infusion center setting.

Your APCs Weekly Monitor is a free weekly e-zine from HCPro, publisher of Briefings on APCs, the monthly newsletter devoted entirely to managing under APCs, and the newsletter, APC Answer Letter, with answers to readers' questions about coding for APCs.

The Monitor is a complimentary companion publication with a specific mission: to provide answers to your tough questions about the APC regulations.

If you have a question about APC coding that you would like addressed in the Monitor, post it on our Web site at himinfo.com. Each week, our team of experts answers questions that will appeal to the majority of readers. The elected questions and their corresponding answers are delivered to your inbox every Friday.

Question: Why does Medicare pay outpatient surgery claims by APCs, which are mapped to CPTs, but surgery departments charge by time?

Answer: Staffing is one of the greatest cost variables in the OR, but other variable costs include equipment, routine supplies, and instruments. None of these items can be charged separately, so they must be reflected in the OR charge. Typically hospitals use five levels of OR time depending on the level of care they are provide.

OR times also vary significantly based upon physician technique and complications. Medicare assigns one set reimbursement amount, but in reality one size does not fit all. Physician technique can account for up to 100% fluctuation in time and resource consumption.

Another drawback to procedure coding in the surgery department is its failure to recognize the economy of scale in costs when more than one procedure at a time is performed. In order to capture the average costs of all providers who perform the procedures, a mid-range price would be set, which would be too high if the procedure was performed as a secondary or third procedure.

Also, a clinician may choose a procedure charge based upon what he or she believes was performed in the OR, while the HIM department would assign a completely different (or more specific) code based upon the medical record.. With the current method, providers only need approximately 10-15 codes in the CDM, but if they charged by procedure they would need a charge for every CPT code.

For more information on this topic, check out next month's June issue of "Briefings on APCs"

ASK THE EXPERT: Can we set up our pharmacy chargemaster so when a drug is infused or injected it automatically assigns the Q0081, 90784, or 90782 code?

Click here for the expert's answer!

PAY PER VIEW Develop a form and review claims to ensure maximum reimbursement for observation

Documentation for observation service is key for proper reimbursement and keeping your facility out of trouble with CMS and the Office of Inspector General.

If you haven't already, try creating an observation medical record form for your facility, says Cheryl D'Amato, RHIT, CCS, director of Health Information Management at HSS, Inc. "This will really help in collecting all the information you need for reimbursement purposes."

Read more here. The cost is $10. Briefings on APCs subscribers have free access via their online subscriptions.

Questions from readers are answered by a team of experts working in the APC area within the health care industry. Their answers are provided as advice. Readers should consult the federal regulations governing OPPS, related CMS sources, and with their local fiscal intermediary before making any decisions regarding the application of OPPS to their particular situations.

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Do you need a documentation improvement resource?
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