• E-mail
• Print
• RSS

Eliminate chargemaster duplication

HIM Connection, October 5, 2004

Want to receive articles like this one in your inbox? Subscribe to HIM Connection!

Duplicate reports of CPT or HCPCS Level II codes for the same service-both by the department performing the service and by the HIM coding specialists- is a common billing problem.

For example, in one hospital, when an outpatient goes to the radiology department to have a needle wire placed in her breast, the radiology technician charges for the breast needle-wire replacement. Because the chargemaster contains code 19290 for this procedure, the technician's reporting of this charge also prompts the chargemaster to generate CPT code 19290 for the breast-needle placement.

However, the HIM coding specialist, upon receipt of the medical record for this patient, also assigns CPT code 19290 and enters the code into the clinical data abstracting software. As a result, code 19290 inappropriately appears on the bill twice, one code having come from the chargemaster and the other from the clinical data-abstracting software. To prevent this duplication, the hospital has to either remove code 19290 from the chargemaster or direct HIM coding specialists to stop reporting CPT code 19290 when this procedure is performed.

To assist hospitals with the prevention or elimination of chargemaster duplication:

• Prohibit chargemaster duplication-the reporting of CPT/HCPCS codes for procedures via the chargemaster (i.e., cardiac catheterization) when the same procedures are also being reported manually by HIM department coders.
• Regularly review the most recent copy of the chargemaster (sorted by CPT code number) with the HIM department coding staff so they are aware of the codes reported via the chargemaster.
• Monitor the American Medical Association's CPT Web site each January and July to determine whether the newly added Category III CPT codes need to reported by the hospital. CPT Category III codes are a temporary set of tracking codes to identify new and emerging technologies. Payment for these services is determined by individual payers, depending on their coverage policy for new technology. If one or more Category III CPT codes need to be reported by the hospital, make sure they are only reported via one source-either the department that will charge for the service or the HIM coding specialists.

This excerpt is adapted from the training manual Mastering the Chargemaster.

Want to receive articles like this one in your inbox? Subscribe to HIM Connection!

• E-mail to a Colleague
• Print
• RSS
• Archive