CMS HIPAA deadline statement
The American Health Information Management Association (AHIMA)
Advantage E-alert reported the following on October 2:
"The Centers for Medicare & Medicaid Services (CMS) has confirmed that after October 16, 2003,
ICD-9-CM procedure codes should not be reported on outpatient claims.
The Healthcare Common Procedure
Coding System (HCPCS) code set is the adopted HIPAA standard for all outpatient services, including those
provided by hospitals. Hospitals may capture ICD-9-CM procedure codes for outpatient services only for
internal use for tracking or monitoring, but these codes should not be reported on outpatient claims. CMS
plans to post an FAQ clarifying this issue."
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: Nasogastric Tube Placement
QUESTION:
We are trying to determine the appropriate code for nasogastric tube placement, and we came across
Hospital Billing Manual section 442.7 that states the following instructions apply to reporting
medical and additional diagnostic services other than radiology.
It says, "CPT-4 codes are used by
physicians to report physician services, and do not necessarily reflect the technical component of a
service furnished by the hospital. Therefore, ignore any wording in the CPT-4 codes that indicates that
the service must be performed by a physician. In cases where there are separate codes for the technical
component, professional component, and/or complete procedure, use the code that represents the technical
component. If there is no technical component code for the service, use the code that represents the
complete procedure."
Would this apply to CPT code 43752, naso- or oro-gastric tube placement, necessitating physician's skill
or would we ignore the physician reference here?
ANSWER:
Under 2003 OPPS, CPT code 43752 has a status indicator E, "Non-Covered Items and Services; Codes not
Payable in Hospital Outpatient Setting; Codes Not Recognized by OPPS but for Which an Alternate Code may
be Applicable."
If processed through APC grouping logic or to the FI, it will evoke OCE 13, "separate payment for
services not provided by Medicare."
Refer to HCPCS Level II code G0272—Naso/oro gastric tube placement, requiring physician's skill and
fluoroscopic guidance (includes fluro, image documentation and report).
This code groups into APC 272, has a status indicator X, and a national unadjusted payment of $69.74.
Remember, HCPCS Level II will supersede Level I or CPT under Medicare's rules. In this case, Medicare has
identified G0272 for payment under OPPS and this code is clearly defined as requiring physician skill.
If no alternate OPPS payable code is found, evaluate the procedure, test, or service to determine whether
it is bundled or packaged into another OPPS payable procedure or considered non-covered under the Medicare
program.
With appropriate medical record documentation, facilities may report G0272 to Medicare for payment of the
technical component under OPPS if the code was performed by a physician as described. If not, the naso/oro
tube placement by a nurse would be a packaged service into another OPPS payable procedure code.
PAY PER VIEW: It's any time night or day: Do you know where your records are?
When cases that hinge on information in a medical record go to court, it's not unusual for the associated
record to vanish.
"Most HIM professionals will say that at some time at every organization records are either lost or
destroyed inadvertently," says Michelle Dougherty, RHIA, practice manager for the American Health
Information Management Association. "It is a much more common component of not only malpractice
cases, but False Claim Act cases, audit matters, and many other types of inquiries than I think people
generally are aware," says William Sarraille, JD, member of the health care practice group at the
Washington, DC, and New York law firm of Arent Fox Kintner Plotkin & Kahn.
Read more HERE. The cost is $10.
Medical Records Briefings subscribers have free
access via their online subscriptions.
ASK THE EXPERT:
We have a psychiatric area outside of our ED. A patient may come into the ED and see the ED physician and
then be sent to the psych area for further evaluation. Different nursing and ancillary staff manage the
patient there. Can we bill for an ED visit and use the psych interview code 90801? What if the psychiatric
practitioner comes to see the patient in the ED and the ED nurses assist with continued care in the ED?
Click here for the EXPERT'S answer.
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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