- New HCPCS codes and their status under the OPPS
- Newly approved drugs and biologicals eligible for pass-through payment
- List of pass-through device category codes in effect as of 10/1/03
- New APC groups
- Modifications to existing HCPCS codes and APC groups
- Modifications to HCPCS status indicators
- Modifications to HCPCS descriptors
- Modifications to APC groups
- Prothrombin Time International Normalized Ratio Monitoring (PT/INR)
- Positron Emission Tomography (PET) scans for thyroid cancer and perfusion of the
heart using ammonia N-13
- New codes for insertion of implantable cardioverter defibrillators (ICD)
- Claims for transcyte for services furnished July 1 through September 30, 2003
Click HERE for complete details of the PM.
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.
TODAY'S TOPIC: CCI edits and the OCE
Question: What Correct Coding Initiative (CCI) edits does the Outpatient Code Editor (OCE) contain? Does it remove certain edits, such as E/M visits? I realize CCI edits for the facility is always a version behind the professional. We have a claims editing system that edits based on CCI for facility v. OCE.
Answer: It is important that facilities use the OCE which couples the CCI edits within it.
The CCI editor is only half the picture. Understanding the OCE will bring the picture into better focus.
The OCE currently incorporates 60 distinct edits under OPPS reimbursement methodology to identify claims issues for the provider. Many providers use claims scrubbers or APC groupers to identify problematic
claims. The edits are resolved internally by designated personnel before the claims are submitted to the FI enabling the provider to receive its entitled
reimbursement.
Within the 60 OCEs, four edits are dedicated to the CCI edits. They are:
- Edit 19—mutually exclusive procedure that is not allowed by
CCI even the appropriate modifier is present, resulting in line item rejection
- Edit 20—Ccomponent of a comprehensive procedure that is not
allowed by CCI even if the appropriate modifier is present, resulting in line item rejection
- Edit 39—mutually exclusive procedure that would be allowed
by CCI if the appropriate modifier were present, resulting in line item rejection
- Edit 40—component of a comprehensive procedure that would
be allowed by CCI if the appropriate modifier were present, resulting in line item rejection
As you mentioned, the CCI edits in the OCE are always one version behind the CCI edits used for physician billing. From dates of service of July 1 through September 30, hospitals will be using version 9.1 and on October 1 until the end of the year they will use version 9.2.
ASK THE EXPERT:
Is it appropriate to code buddy taping as strapping? Is it appropriate to code rib belts as 21800, "closed treatment of rib fracture"?
Read HERE for the expert's answer!
TIP OF THE WEEK: Make sure coders and physicians meet face-to-face.
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.
EDITOR'S CHOICE
It's time to prepare for the new 2004 ICD-9-CD codes
And we have just what you need to get ready.
It's the 2004 ICD-9-CD Training Kit. You get a trainer's package with a plan to help educate staff on all of the changes, along with flyers and a Q&A section.
You also get 10 coder handbooks, which include reference guides and clinical explanations for each new code so coders understand why and how each code should be applied.
It's a steal of a deal at only $99. If you need more, we'll sell you additional coder handbooks in packages of 10.
Ordering is easy. Just
CLICK HERE, or call our customer service department at 800-650-6787. Be sure to mention Source Code EB21900B.
Audioconference covers DRG changes
Effective October 1, annual changes to DRG relative weights and descriptions impact inpatient coding and reimbursement. Coders need timely updates so they transition to the new codes. Finance and reimbursement staff need to understand the impact the changes will have on the case mix index and length of stay analysis. Physicians need to understand the changes so their documentation will be clear and timely.
Let us help you get ready. Join us for "2004 DRG Update: How to Analyze the Impact and Educate Your Staff" on October 8 beginning at 1 p.m. Eastern.
For more information or to register, CLICK HERE, or call our Customer Service Team at 800/650-6787. Be sure to mention source code EZ22285A.
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