Codes subject to OCE Edit 15 named
APCs Weekly Monitor, May 28, 2003
Want to receive articles like this one in your inbox? Subscribe to APCs Weekly Monitor!
| ||
| Briefings on APCs FREE Sample | APC Answer Letter FREE Sample | HIMINFO.com |
| Friday,
What is believed to be mankind's oldest surgical procedure? The answer will appear in next week's APC Weekly Monitor, or be one of the first five to e-mail the correct answer and win a 3-month free trial to one of our APC newsletters!
LAST WEEK'S ANSWER:
"Briefings on APCs" is a monthly newsletter devoted entirely to managing under APCs, including tips, charts, and advice from the experts. "APC
Answer Letter" is a question and answer publication - readers supply
the questions, our experts supply the answers. Click on the links to find
out more.
THE MONITOR'S ADVISORY BOARD Keith Siddel, Cheryl D'Amato, Julie Downey, Carole Gammarino, Julia R. Palmer Valerie Rinkle, MPA, On Himinfo.com |
Friday,
What is believed to be mankind's oldest surgical procedure?
The answer will appear in next week's APC Weekly Monitor, or be one of
the first five to e-mail the correct answer and win a 3-month free trial to one of our APC newsletters!
LAST WEEK'S ANSWER:
"Briefings
on APCs" is a monthly newsletter devoted entirely to managing under
APCs, including tips, charts, and advice from the experts.
"APC
Answer Letter" is a question and answer publication - readers supply
the questions, our experts supply the answers. Click on the links to find
out more. Medical Necessity Solutions
With Info-X you can integrate your local LMRPs and NCDs into your HIS.
Leverage existing system capabilities to provide ABN alert, print the ABN
and apply the appropriate occurrence codes.
Increased reimbursement, minimum cost, risk, infrastructure,
training/education & least time to implement.
For more information, click here or call 800-299-1091 ext. 34.
IRP's CODING SOFTWARE
Specifically designed for Medicare APC compliance, IRP's coding
software fits ALL platforms and is easily integrated with existing
applications. Visit our comprehensive APC Reference Library.
Click or call
800-634-0496 x244.
THE MONITOR'S ADVISORY BOARD
Keith Siddel, Cheryl D'Amato, Julie Downey, Carole Gammarino, Julia R. Palmer Valerie Rinkle, MPA, On Himinfo.com
Codes subject to OCE Edit 15 named
CMS put Edit 15 (service unit out of range for procedure) back in play on April 1, 2003, but did not identify which OPPS codes would be affected by the edit.
The following six codes are currently subject to the edit:
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 a question that will appeal to
the majority of readers. The elected question and the corresponding
answer are delivered to your inbox every Friday. Question: Do we use code 94664 only when a patient will be
self-administering his or her therapy? Is a specific physician's order
required for the patient to be taught?
What is included in the initial therapy? Does it include the routine
education or is it specific to those patients who will be using the therapy
at home? Should 94640 ever be used for the initial treatment?
Answer:
94664 includes the demonstration and/or evaluation of patient use of an
aerosol generator, nebulizer, metered dose inhaler, or intermittent positive pressure breathing device. This
service may be provided in various hospital outpatient departments or in the ER.
94664 can only be reported one time per day. It includes the
education by the respiratory therapist prior to the patient
self-administering the treatment. This service should either be
ordered by the physician, or a committee-approved patient
protocol.
94640 is used to report the actual treatment typically administered by an RT
or RN. This code can be reported more than once on the same day if
modifier -76 is appended.
However, according the the National Correct Coding Initiative, 94664 must be entered alone when demonstrating the use of the respiratory
device to the patient. If a treatment is given on the same, by the same personnel in the same
department as the
demonstration/evaluation of the patient use of the device, 94664 becomes a
component of the more comprehensive procedure 94640. When the demonstration/evaluation is performed
in a different department, by different personnel, it may qualify for
modifier -59.
When using these treatments in the ER, 94640 carries a status
indicator of S so it is not subject to multiple procedure discounting. If
this is the only procedure performed during the visit, modifier -25 should
be
appended to the E/M level code to ensure reimbursement for this procedure.
ASK
THE EXPERT: A patient comes into the ED by ambulance. The IV was started in the field and they were also infusing saline. The nurses in the ED start a second bag of saline. Can we charge for an infusion?
Click here for the expert's answer!
PAY PER VIEW:
One simple diagnosis-bunions-can involve one of nearly a dozen CPT procedure codes. Coders need to use every piece of information in the operative report to correctly code bunion repairs.
Read more here. The cost is $10. Briefings on APCs subscribers have free access via their online subscriptions.
Coding and Compliance Feature Article of the Month:
Interventional procedures cause coding confusion
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.
Is your Chargemaster up-to-date? Plan to spend 90 minutes on June 17 for an important audioconference, "Essential Chargemaster Maintenance: Best Practices to Ensure Positive Financial Outcomes and Compliance." It's a small investment compared to what you could be losing.
To learn more or to register, CLICK HERE or call our customer service department at 800/650-6787. Be sure to mention source code EZ0175B.
It's time to "Lunch & Learn" about health care report cards and coding for severity
Have you ever wondered how your hospital and physicians would fare if graded against another facility in your area? That information is available to the public on consumer Web sites. It is essential that your hospital's data accurately reflect clinical documentation.
Gather your colleagues for a brown bag lunch and listen to the easy-to-understand "Coding Lunch & Learn: Health Care Report Cards and Coding for Severity" from HP3 and HCPro. Train every member of your department and award them each a certificate for valuable continuing education credits.
For more information,
CLICK HEREor call our customer service department at 800/650-6787. Be sure to mention source code EZ0819A.
SIGN UP FOR A FREE CODER TRAINING E-MAIL NEWSLETTER
Sign up for your complimentary subscription to hcProCoder Connection today and you're on your way to better compliance with the OIG, CMS, and other regulatory standards. Every two weeks you'll get the latest issue of delivered right to your e-mail's inbox. Each edition will feature a training quiz to keep you sharp on correct coding. The first issue launches June 4. Subscribe today, click here.
CMS put Edit 15 (service unit out of range for procedure) back in play on April 1, 2003, but did not identify which OPPS codes would be affected by the edit.
The following six codes are currently subject to the edit:
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 a question that will appeal to
the majority of readers. The elected question and the corresponding
answer are delivered to your inbox every Friday. Question: Do we use code 94664 only when a patient will be
self-administering his or her therapy? Is a specific physician's order
required for the patient to be taught?
What is included in the initial therapy? Does it include the routine
education or is it specific to those patients who will be using the therapy
at home? Should 94640 ever be used for the initial treatment?
Answer:
94664 includes the demonstration and/or evaluation of patient use of an
aerosol generator, nebulizer, metered dose inhaler, or intermittent positive pressure breathing device. This
service may be provided in various hospital outpatient departments or in the ER.
94664 can only be reported one time per day. It includes the
education by the respiratory therapist prior to the patient
self-administering the treatment. This service should either be
ordered by the physician, or a committee-approved patient
protocol.
94640 is used to report the actual treatment typically administered by an RT
or RN. This code can be reported more than once on the same day if
modifier -76 is appended.
However, according the the National Correct Coding Initiative, 94664 must be entered alone when demonstrating the use of the respiratory
device to the patient. If a treatment is given on the same, by the same personnel in the same
department as the
demonstration/evaluation of the patient use of the device, 94664 becomes a
component of the more comprehensive procedure 94640. When the demonstration/evaluation is performed
in a different department, by different personnel, it may qualify for
modifier -59.
When using these treatments in the ER, 94640 carries a status
indicator of S so it is not subject to multiple procedure discounting. If
this is the only procedure performed during the visit, modifier -25 should
be
appended to the E/M level code to ensure reimbursement for this procedure.
ASK
THE EXPERT: A patient comes into the ED by ambulance. The IV was started in the field and they were also infusing saline. The nurses in the ED start a second bag of saline. Can we charge for an infusion?
Click here for the expert's answer!
PAY PER VIEW:
One simple diagnosis-bunions-can involve one of nearly a dozen CPT procedure codes. Coders need to use every piece of information in the operative report to correctly code bunion repairs.
Read more here. The cost is $10. Briefings on APCs subscribers have free access via their online subscriptions.
Coding and Compliance Feature Article of the Month:
Interventional procedures cause coding confusion
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.
Is your Chargemaster up-to-date? Plan to spend 90 minutes on June 17 for an important audioconference, "Essential Chargemaster Maintenance: Best Practices to Ensure Positive Financial Outcomes and Compliance." It's a small investment compared to what you could be losing.
To learn more or to register, CLICK HERE or call our customer service department at 800/650-6787. Be sure to mention source code EZ0175B.
It's time to "Lunch & Learn" about health care report cards and coding for severity
Have you ever wondered how your hospital and physicians would fare if graded against another facility in your area? That information is available to the public on consumer Web sites. It is essential that your hospital's data accurately reflect clinical documentation.
Gather your colleagues for a brown bag lunch and listen to the easy-to-understand "Coding Lunch & Learn: Health Care Report Cards and Coding for Severity" from HP3 and HCPro. Train every member of your department and award them each a certificate for valuable continuing education credits.
For more information,
CLICK HEREor call our customer service department at 800/650-6787. Be sure to mention source code EZ0819A.
SIGN UP FOR A FREE CODER TRAINING E-MAIL NEWSLETTER
Sign up for your complimentary subscription to hcProCoder Connection today and you're on your way to better compliance with the OIG, CMS, and other regulatory standards. Every two weeks you'll get the latest issue of delivered right to your e-mail's inbox. Each edition will feature a training quiz to keep you sharp on correct coding. The first issue launches June 4. Subscribe today, click here.
Want to receive articles like this one in your inbox? Subscribe to APCs Weekly Monitor! | ||||||||||
