Health Information Management Articles by Topic: APCs
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Briefings on APCs, Issue 3, March 1, 2014
Although the AMA changed hundreds of codes in the 2014 CPT® Manual, most of the changes...
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Briefings on APCs, Issue 3, March 1, 2014
When an NCCI edit occurs on a claim, providers can go directly to CMS’ website and...
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Briefings on APCs, Issue 3, March 1, 2014
Coders are aware that ICD-10-CM will allow much more specificity than ICD-9-CM, and that is...
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Briefings on APCs, Issue 3, March 1, 2014
CMS has been making it clear over the years that packaging would become a larger and larger...
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APCs Insider, Issue 4, January 24, 2014
There’s no question as October 1 approaches that the transition to ICD-10 will have a huge...
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APCs Insider, Issue 4, January 24, 2014
Q: Did CMS make any changes to the inpatient-only list for 2014?
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APCs Insider, Issue 3, January 17, 2014
Q: Did CMS discontinue the device-to-procedure and radiopharmaceutical-to-nuclear medicine...
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APCs Insider, Issue 2, January 10, 2014
Q: Which drugs and biologicals have pass-through status for 2014?
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APCs Insider, Issue 51, December 13, 2013
Q: Will we need to continue appending the modifier when we receive credit for a device from the...
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APCs Insider, Issue 50, December 6, 2013
CMS may not have finalized all of its sweeping proposals in the 2014 OPPS Final Rule released...
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APCs Insider, Issue 50, December 6, 2013
Q: We have started our charge description master (CDM) updates for 2014 and wonder if there will be...
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APCs Insider, Issue 50, December 6, 2013
Accurate time documentation is critical for drug administration coding because it can sometimes...
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APCs Insider, Issue 49, November 22, 2013
For many, this is the time of year when the latest updated rules, regulations, and payment rates...
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APCs Insider, Issue 49, November 22, 2013
Q: An observation patient received an IV push on the first day (9/28) and an infusion the...
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APCs Insider, Issue 47, November 8, 2013
CMS has released its update of the latest tests approved by the FDA as waived tests under the...
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APCs Insider, Issue 44, October 18, 2013
After 16 days of negotiation, brinkmanship, and finally, agreement, the government shutdown ended...
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APCs Insider, Issue 44, October 18, 2013
Q: Our MAC has recently updated the self-administered drug (SAD) listing and removed...
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APCs Insider, Issue 40, September 20, 2013
As September comes to a close and the calendar turns to October, the healthcare industry will be...
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APCs Insider, Issue 39, September 13, 2013
As the use of electronic health records (EHR) grows, providers across the country are learning that...
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APCs Insider, Issue 39, September 13, 2013
Q: We have started administering the flu vaccine using Fluzone, but the CPT® code has a...
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APCs Insider, Issue 38, September 6, 2013
CMS recently released a transmittal updating payment rates, status indicators, and device...
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APCs Insider, Issue 38, September 6, 2013
Q: Has CMS established any new pass-through device categories for October?
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APCs Insider, Issue 38, September 6, 2013
Checking a patient's glucose by glucometer is reasonable before a PET scan for patient care and...
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APCs Insider, Issue 36, August 23, 2013
Receiving a billing rejection can be frustrating, especially when you’re confident the...
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APCs Insider, Issue 36, August 23, 2013
Q: An external company audited our outpatient cardiology department. Our physicians write an order...
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APCs Insider, Issue 36, August 23, 2013
CMS recently added two new codes for payment of new brachytherapy sources for which source codes...
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APCs Insider, Issue 35, August 16, 2013
By Steven Andrews
Coders may often feel like CMS imposes major changes on rules and...
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APCs Insider, Issue 34, August 9, 2013
Q: We perform a mammogram after a breast procedure, like placement of a needle localization wire or...
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APCs Insider, Issue 33, August 2, 2013
At first glance, CMS’ proposal to eliminate the device-to-procedure and procedure-to-device...
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APCs Insider, Issue 28, July 12, 2013
In the past, outpatient facilities only worried about the OPPS proposed rule, inpatient facilities...
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APCs Insider, Issue 13, March 29, 2013
Q: We heard that CMS will reduce payment for CPT® code 77371 (radiation treatment delivery...
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APCs Insider, Issue 3, January 18, 2013
CMS finalized a change to the way it generates APC relative weights: For 2013, the agency will use...
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APCs Insider, Issue 1, January 4, 2013
Q: In the 2013 OPPS Addendum B, when we look up a specific CPT® code, it shows status indicator...
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APCs Insider, Issue 51, December 21, 2012
Q: We are applying modifiers to line items on claims to bypass the National Correct Coding...
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JustCoding News: Outpatient, Issue 32, August 8, 2012
As part of the July update to the Intergrated Outpatient Code Editor, CMS reinstated HCPCS C1882 to...
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APCs Insider, Issue 27, July 13, 2012
Q: In the calendar year (CY) 2012 final OPPS rule, CMS noted that the APC Panel would be...
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JustCoding News: Outpatient, Issue 28, July 11, 2012
CMS is proposing two major changes as part of the 2013 Outpatient Prospective Payment System (OPPS...
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APCs Insider, Issue 7, February 17, 2012
Q. What new composites, if any, did CMS create for 2012?
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APCs Insider, Issue 2, January 13, 2012
Q: Our billing office is concerned about reports that the OIG is auditing for appropriate use of...
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APCs Insider, Issue 41, October 7, 2011
Q. We would like to charge for the wound and ostomy supplies used in our hospital outpatient wound...
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APCs Insider, Issue 35, August 26, 2011
Q: Fall is sneaking up on us as we near the end of summer. What are most the important tasks that...
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APCs Insider, Issue 35, August 26, 2011
CMS’ plan to cap payment for cardiac resynchronization therapy (CRT) based on Medicare...
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APCs Insider, Issue 32, August 12, 2011
Q: Has CMS provided any updates regarding image-guided minimally invasive lumbar decompression...
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APCs Insider, Issue 32, August 12, 2011
Editor’s note: Kimberly Anderwood Hoy, JD, CPC, Director of Medicare and compliance at HCPro...
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APCs Insider, Issue 15, April 15, 2011
Q: We’ve been reporting the new combination CPT® code for a CT of the abdomen and pelvis...
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APCs Insider, Issue 15, April 15, 2011
Q: We’ve been reporting the new combination CPT® code for a CT of the abdomen and pelvis...
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APCs Insider, Issue 14, April 8, 2011
Q: Some of our drug charges with HCPCS J-codes are rolled into revenue code 250 (pharmacy) on the...
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APCs Insider, Issue 4, January 28, 2011
Q: The 2011 CPT® Manual includes code 0232T for injection(s), platelet rich plasma, any tissue...
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APCs Insider, Issue 4, January 28, 2011
Medicare recognizes the 2011 CPT® Manual’s drug administration codes, and hospitals...
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APCs Insider, Issue 1, January 7, 2011
Q: Did CMS provide any new updates for hyperbaric oxygen (HBO) therapy services for 2011?
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APCs Insider, Issue 44, October 29, 2010
Q: People in our hospital use the terms “bundling” and “packaging&rdquo...
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APCs Insider, Issue 28, July 9, 2010
Modifier -25 indicates a “significant, separately identifiable E/M service by the same...
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Briefings on APCs, Issue 7, July 1, 2010
Many HIM professionals, coders, and billers continue to struggle with correct coding for injections...
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Briefings on APCs, Issue 7, July 1, 2010
The technical nature of the CPT coding system can be very challenging for coding specialists, and...
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Briefings on APCs, Issue 7, July 1, 2010
As reimbursement for complex pain management continues to decrease, your coding must drive accurate...
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Briefings on APCs, Issue 7, July 1, 2010
A patient comes into your outpatient facility for a minor surgical procedure and the physician...
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Briefings on APCs, Issue 7, July 1, 2010
Inside:
Is that E/M service really above and beyond the norm?
Cure what ails your pain...
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APCs Insider, Issue 25, June 18, 2010
Hyperbaric oxygen (HBO) therapy is a relatively new service, so the various MACs and FIs interpret...
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APC Payment Insider, Issue 6, June 1, 2010
In this month's coding Q&A, our experts answer questions about how to report Unna boot...
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APC Payment Insider, Issue 6, June 1, 2010
The sheer number of modifiers can cause plenty of confusion for HIM staff. The rules about which...
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APC Payment Insider, Issue 6, June 1, 2010
Hyperbaric oxygen (HBO) therapy is a relatively new service, meaning different MACs and FIs...
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Briefings on APCs, Issue 6, June 1, 2010
CMS added 10 new HCPCS codes and six new APCs to the I/OCE as part of Transmittal R1927CP’s...
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Briefings on APCs, Issue 6, June 1, 2010
The sheer number of modifiers can cause plenty of confusion for HIM staff. The rules about which...
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Briefings on APCs, Issue 6, June 1, 2010
When CMS released its physician supervision requirements as part of the 2010 OPPS final rule...
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Briefings on APCs, Issue 6, June 1, 2010
In this month's issue, we detail the importance of prequalifying patients for hyperbaric oxygen...
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APCs Insider, Issue 21, May 21, 2010
Q. Our question pertains to Unna boot application. Is it true that we may not bill 29580...
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APCs Insider, Issue 21, May 21, 2010
In one-time notification R617OTN, CMS notes that organizations can report reasonable and necessary...
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APCs Insider, Issue 20, May 14, 2010
Drug compendia are designed to educate their users with respect to both clinical and financial...
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APCs Insider, Issue 19, May 7, 2010
Q: My question pertains to new CPT code 29581 (application of multi-layer venous wound compression...
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APCs Insider, Issue 19, May 7, 2010
CMS now denies claim lines with units of service that exceed the medically unlikely edit (MUE) for...
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Briefings on APCs, Issue 5, May 1, 2010
CMS representatives discussed the three-day rule and pulmonary rehab supervision during a Hospital...
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Briefings on APCs, Issue 5, May 1, 2010
A therapist spends five minutes performing an ultrasound and performs 20 minutes of therapeutic...
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Briefings on APCs, Issue 5, May 1, 2010
Add one more thing to your list of items to track: medically unlikely edit (MUE) denials and...
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Briefings on APCs, Issue 5, May 1, 2010
In a perfect world, CMS and other payers would reimburse facilities and physicians for every...
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Briefings on APCs, Issue 5, May 1, 2010
Inside: Complex compendia rules complicate reimbursement Now on the to-track list: Medically...
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APC Payment Insider, Issue 5, May 1, 2010
A therapist spends five minutes performing an ultrasound and performs 20 minutes of therapeutic...
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APC Payment Insider, Issue 5, May 1, 2010
Add one more thing to your list of items to track: medically unlikely edit (MUE) denials and...
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APC Payment Insider, Issue 5, May 1, 2010
In this issue, we explain how CMS’ decision to denial units in excess of medically unlikely...
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APCs Insider, Issue 17, April 23, 2010
Q: Can you explain use of CPT modifier -50, bilateral procedure and the reporting for outpatient...
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APCs Insider, Issue 17, April 23, 2010
When you audit drug administration, begin by looking for proper documentation. Look for signed and...
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APCs Insider, Issue 16, April 16, 2010
Some therapies are considered edited pairs and are not billable on the same date of service unless...
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APCs Insider, Issue 16, April 16, 2010
Q: How should we report DERMABOND® wound repair? Does this differ depending on whether the...
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APCs Insider, Issue 15, April 9, 2010
Q: For a patient in observation, a nurse provides CPT code 51702 (insertion of temporary indwelling...
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APCs Insider, Issue 15, April 9, 2010
Condition code 44 changes a patient’s initial inpatient status to outpatient for purposes of...
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APCs Insider, Issue 13, April 2, 2010
Condition code 44 changes a patient’s initial inpatient status to outpatient for purposes of...
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APC Payment Insider, Issue 4, April 1, 2010
To take advantage of the new Medicare benefits for cardiac and pulmonary rehab services, coders...
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APC Payment Insider, Issue 4, April 1, 2010
In this issue, we explain the necessity of differentiating between mandatory and voluntary ABNs and...
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Briefings on APCs, Issue 4, April 1, 2010
In an environment of increasing audits, hospitals must monitor and resolve drug administration...
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Briefings on APCs, Issue 4, April 1, 2010
When an outpatient physical therapist provides exercise using land- and water-based therapy to the...
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Briefings on APCs, Issue 4, April 1, 2010
As if condition code 44 weren’t confusing enough, observation services and physician...
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Briefings on APCs, Issue 4, April 1, 2010
Mrs. Smith arrives in the ED at 8 a.m. Tuesday. Dr. Jones writes an admission order at 11:45 a.m...
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Briefings on APCs, Issue 4, April 1, 2010
In this issue, we explain the basics of condition code 44 and explore the challenges presented by...
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HIM-HIPAA Insider, Issue 12, March 30, 2010
In 2003, HCPro, Inc., Nimitt Consulting, Inc., and 3M Health Information Systems joined forces to...
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Briefings on APCs, Issue 5, March 26, 2010
Coders know that, with few exceptions, they may not report something that a physician has not...
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APCs Insider, Issue 12, March 26, 2010
Q: A physician orders one dose of a medication to be administered intramuscularly (IM) or...
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APCs Insider, Issue 12, March 26, 2010
CMS introduced NCCI edits for outpatient therapy in 1996 to prevent improper payment when...
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APCs Insider, Issue 12, March 26, 2010
In 2003 HCPro, Inc., Nimitt Consulting, Inc., and 3M Health Information Systems joined forces to...
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APCs Insider, Issue 11, March 20, 2010
Q: Does severity of illness affect APC reimbursement under the hospital OPPS as it does under the...
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APCs Insider, Issue 11, March 19, 2010
Should hospitals charge for open but unused supplies when a patient is brought to the OR and...
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APCs Insider, Issue 10, March 12, 2010
Q: Should we use CPT modifier -59 (distinct procedural service) for a preoperative EKG performed on...
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APCs Insider, Issue 10, March 12, 2010
CMS’ decision allowing facilities to voluntarily provide patients with an ABN for statutorily...
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APCs Insider, Issue 9, March 5, 2010
Q: My hospital has multi-specialty, provider-based clinics, so when billing for clinic visits, we...
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APCs Insider, Issue 9, March 5, 2010
One challenge for coding drugs is ensuring that you code them according to their descriptions...
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APC Payment Insider, Issue 3, March 1, 2010
Cardiac and pulmonary rehabilitation program coordinators face plenty of challenges as they...
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APC Payment Insider, Issue 3, March 1, 2010
Coders will find more than 450 changes in the 2010 CPT Manual, with the most significant...
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APC Payment Insider, Issue 3, March 1, 2010
In this issue, we examine some of the major CPT code changes for 2010 and review the coding...
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APCs Insider, Issue 8, February 26, 2010
Q: If a physical performance test is conducted (97750, physical performance test or measurement...
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APCs Insider, Issue 8, February 26, 2010
Never events, such as wrong-site surgeries, are actually rare events, says Alsie Fitzgerald, RN...
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APCs Insider, Issue 7, February 19, 2010
Q: Which revenue code should we use to report wound care if an occupational therapist or physical...
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APCs Insider, Issue 7, February 19, 2010
All Medicare patients with moderate, severe, or very severe classifications of chronic obstructive...
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APCs Insider, Issue 6, February 12, 2010
Q: May we report CPT code 94002 for a patient started on a ventilator in the ED? Must the patient...
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APCs Insider, Issue 6, February 12, 2010
In the 2010 Medicare Physician Fee Schedule final rule, CMS restates its self-described...
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APCs Insider, Issue 4, February 5, 2010
The revised CPT codes for hemorrhoids may be problematic for coders. Avoid confusion by developing...
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APC Payment Insider, Issue 2, February 1, 2010
CMS adopted a new standard for supervision of therapeutic services provided in a hospital or...
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APC Payment Insider, Issue 2, February 1, 2010
CMS revised requirements for physician supervision and finalized a variety of drug reimbursement...
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APC Payment Insider, Issue 2, February 1, 2010
In this issue examine how to properly assign modifiers. This issue also contains our index of 2009...
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Briefings on APCs, Issue 2, February 1, 2010
If your healthcare organization doesn’t require a physician signature on all orders for...
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Briefings on APCs, Issue 2, February 1, 2010
In October 2009, an orthopedic surgeon at Rhode Island Hospital operated on the wrong finger of a...
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Briefings on APCs, Issue 2, February 1, 2010
Cardiac and pulmonary rehabilitation program coordinators face plenty of challenges as they...
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Briefings on APCs, Issue 2, February 1, 2010
Three changes in diagnostic and interventional radiology will require coders to rethink how they...
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Briefings on APCs, Issue 2, February 1, 2010
Editor’s note: This is the second article in a two-part series on the 2010 CPT code changes...
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Briefings on APCs, Issue 2, February 1, 2010
In this issue, we examine specific CPT code changes for 2010. We also explain the new cardiac and...
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APCs Insider, Issue 4, January 29, 2010
The AMA made a significant number of changes to soft tissue and bone tumor excision codes for 2010...
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APCs Insider, Issue 3, January 22, 2010
The AMA has significantly changed musculoskeletal system codes pertaining to soft tissue and bone...
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APCs Insider, Issue 2, January 15, 2010
Q: We submitted claims to Medicare for the H1N1 flu vaccine using CPT code 90470 (H1N1 immunization...
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APCs Insider, Issue 2, January 15, 2010
Training employees is the important thing employers can do to prevent “never events.”
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APCs Insider, Issue 1, January 8, 2010
Q: All of a sudden we are receiving recoupments for some lab work we performed. The information...
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APCs Insider, Issue 1, January 8, 2010
In order for your facility to be reimbursed for FDG PET scans, you need to properly bill them. One...
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Briefings on APCs, Issue 1, January 1, 2010
Track down that hard-to-find Briefings on APCs article. Use our index to find articles we published...
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Briefings on APCs, Issue 1, January 1, 2010
CMS’ recent national coverage determination (NCD) is fairly straightforward, spelling out...
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Briefings on APCs, Issue 1, January 1, 2010
CMS adopted a new standard for supervision of therapeutic services provided in a hospital or...
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Briefings on APCs, Issue 1, January 1, 2010
CMS revised requirements for physician supervision and finalized a variety of drug reimbursement...
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Briefings on APCs, Issue 1, January 1, 2010
In this issue, we examine the 2010 OPPS final rule, including the changes to drug reimbursement and...
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APC Payment Insider, Issue 1, January 1, 2010
Track down that hard-to-find APC Payment Insider article. Use our index to find articles we...
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APC Payment Insider, Issue 1, January 1, 2010
Proper modifier use is a critical part of coding, billing, and reimbursement. Currently, coders can...
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APC Payment Insider, Issue 1, January 1, 2010
In this issue examine how to properly assign modifiers. This issue also contains our index of 2009...
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APCs Insider, Issue 49, December 18, 2009
CMS’ 2010 OPPS final rule addresses a new benefit, coverage of kidney disease education...
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APCs Insider, Issue 48, December 11, 2009
Q: Can we code bladder catheterizations when a urine specimen is obtained for an analysis and the...
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APCs Insider, Issue 48, December 11, 2009
Physicians sometimes decide to perform surgery in stages. These situations involve a planned return...
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APCs Insider, Issue 47, December 4, 2009
Procedural modifiers can provide a wealth of information to further describe services provided...
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APC Payment Insider, Issue 12, December 1, 2009
Hospital departments may be missing revenue for supplies because they don’t understand the...
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APC Payment Insider, Issue 12, December 1, 2009
In this issue examine how to properly bill for supplies to eliminate lost revenue.
Inside...
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Briefings on APCs, Issue 12, December 1, 2009
If you thought you understood CMS’ policy when it comes to physician orders for clinical...
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Briefings on APCs, Issue 12, December 1, 2009
Proper modifier use is a critical part of coding, billing, and reimbursement. Currently, coders can...
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Briefings on APCs, Issue 12, December 1, 2009
Understand how to sift through detailed OB/GYN operative notes to ensure accurate code assignment.
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Briefings on APCs, Issue 12, December 1, 2009
Operational inefficiencies, outdated technology, and silo thinking can all lead to lost revenue...
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Briefings on APCs, Issue 12, December 1, 2009
In this issue, we examine outpatient coding challenges that facilities are still facing. We unravel...
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APCs Insider, Issue 46, November 20, 2009
When coding OB/GYN procedures, remember that ICD-9 codes 630–679 in Chapter 11 (Complications...
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APCs Insider, Issue 46, November 20, 2009
Q: Can our hospital code and bill telemetry daily monitoring in conjunction with a chest pain...
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APCs Insider, Issue 45, November 13, 2009
Q: A surgeon excises a lesion on a patient’s back, but fails to document its size or the...
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APCs Insider, Issue 45, November 13, 2009
When considering ways to reduce revenue loss at your facility, don’t look just for big-dollar...
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APCs Insider, Issue 44, November 6, 2009
Q. Several of our facilities that include hospital-based outpatient wound care clinics have...
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APCs Insider, Issue 44, November 6, 2009
If you perform a level IV surgical pathology (88305) on more than one specimen from the same...
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APC Payment Insider, Issue 11, November 1, 2009
Learn how to correctly use modifier -59 and when to avoid it.
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APC Payment Insider, Issue 11, November 1, 2009
Given the continuing confusion, what can facilities do to handle MUEs?
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APC Payment Insider, Issue 11, November 1, 2009
In this issue we unravel the mysteries surrounding medically unlikely edits.
Inside:
&bull...
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Briefings on APCs, Issue 11, November 1, 2009
Our experts answer questions about the appropriate use of modifier -59.
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Briefings on APCs, Issue 11, November 1, 2009
Condition code 44, billing for radiopharmaceuticals highlight I/OCE changes
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Briefings on APCs, Issue 11, November 1, 2009
Make sure you are coding and billing supplies correctly to decrease revenue loss.
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Briefings on APCs, Issue 11, November 1, 2009
The second part of our two-part series on supervision requirements for diagnostic services.
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Briefings on APCs, Issue 11, November 1, 2009
This issue features the second part of our series on physician supervision requirements for...
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APCs Insider, Issue 43, October 30, 2009
All diagnostic tests require some level of physician supervision. Staff members need to know the...
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APCs Insider, Issue 43, October 30, 2009
Q. A patient who has undergone a kidney transplant and has plasmapheresis intravenously receives IV...
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APCs Insider, Issue 42, October 23, 2009
Q: A patient with multiple wounds at different sites receives active wound management at one wound...
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APCs Insider, Issue 42, October 23, 2009
Facilities need to have a clear understanding of when a procedure is diagnostic and when it is...
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APCs Insider, Issue 41, October 16, 2009
In FAQ 8736, CMS instructs hospitals how to report units in excess of the medically unlikely edits...
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APCs Insider, Issue 39, October 2, 2009
Q: How should we assign CPT codes for an infusion of desferal at the same time as blood products...
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APCs Insider, Issue 39, October 2, 2009
How can your facility ensure compliance with the physician supervision requirements for diagnostic...
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APC Payment Insider, Issue 10, October 1, 2009
Does CPT 36592 pertain to a pre-existing catheter (such as a PICC line) that is available for use...
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APC Payment Insider, Issue 10, October 1, 2009
CMS proposes new methodology to calculate drug APC payment rates.
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APC Payment Insider, Issue 10, October 1, 2009
Proposed changes to outpatient supervision could be a huge boon.
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Briefings on APCs, Issue 10, October 1, 2009
Coders must understand what constitutes a ‘screening’ colonoscopy.
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Briefings on APCs, Issue 10, October 1, 2009
Given the continuing confusion, what can facilities do to handle MUEs?
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Briefings on APCs, Issue 10, October 1, 2009
The first part of our two-part series on supervision requirements for diagnostic services.
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Briefings on APCs, Issue 10, October 1, 2009
This issue features the first part of our series on physician supervision requirements for...
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APCs Insider, Issue 38, September 25, 2009
Q: Is elective cardioversion code 92960 billable in the ED? For example, a patient presents in the...
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APCs Insider, Issue 37, September 18, 2009
Q: We understand that we cannot charge for the use of equipment, but can we charge for the soft...
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APCs Insider, Issue 37, September 18, 2009
Under the 2009 OPPS final rule, bundling is now subdivided into status indicators Q1, Q2, and Q3.
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APCs Insider, Issue 36, September 11, 2009
To distinguish between bundled and packaged services, remember that bundling applies to coding and...
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APCs Insider, Issue 35, September 5, 2009
Q. A physician orders one dose of a medication to be administered intramuscularly (IM) or...
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APCs Insider, Issue 35, September 4, 2009
In its 2010 OPPS proposed rule, CMS acknowledges never having specifically defined...
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Briefings on APCs, Issue 9, September 1, 2009
In this issue, you will find an overview of the 2010 OPPS proposed rule, plus articles expanding on...
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Briefings on APCs, Issue 9, September 1, 2009
The text portion of the 2010 OPPS proposed rule is shorter than previous years’ rules, and...
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Briefings on APCs, Issue 9, September 1, 2009
Proposed changes to outpatient supervision could be a huge boon.
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Briefings on APCs, Issue 9, September 1, 2009
CMS proposes new methodology to calculate drug APC payment rates.
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Briefings on APCs, Issue 9, September 1, 2009
Several items of interest to OPPS hospitals from Open Door Forum call.
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Briefings on APCs, Issue 9, September 1, 2009
Q status indicators add to packaged vs. bundled confusion.
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APC Answer Letter, Issue 9, September 1, 2009
Select proper codes, modifiers for cardiac catheterization, injections and infusions, stent...
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APC Payment Insider, Issue 9, September 1, 2009
In this issue we look at how the new ICD-9-CM codes increase specificity.
Inside:
CMS...
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APC Payment Insider, Issue 9, September 1, 2009
ICD-9 code changes increase specificity to provide more information.
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APC Payment Insider, Issue 9, September 1, 2009
CMS revised language to clarify outpatient observation services.
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APC Payment Insider, Issue 9, September 1, 2009
Physician can’t cross lesion to place noncoronary stent
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APC Payment Insider, Issue 9, September 1, 2009
What should you do if a physician can’t complete the procedure?
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APC Payment Insider, Issue 9, September 1, 2009
What should you do if a physician can’t complete the procedure?
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APC Payment Insider, Issue 9, September 1, 2009
Is charging a patient for a low level facility visit appropriate?
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APC Payment Insider, Issue 9, September 1, 2009
Make sure you include CPT and HCPCS codes for drugs
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APC Payment Insider, Issue 9, September 1, 2009
Know when to report an IV push of the same substance in ER
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APCs Insider, Issue 33, August 28, 2009
Q: Is a patient who underwent a colonoscopy and polyp removal three years ago considered high risk...
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APCs Insider, Issue 33, August 28, 2009
CMS requests that everyone who submitted comments on the 2010 proposed Physician Fee Schedule or...
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APCs Insider, Issue 32, August 21, 2009
Q: How should we code the following scenario: A patient arrives at the catheterization laboratory...
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APCs Insider, Issue 32, August 21, 2009
What do you thinkof the 2010 OPPS proposed rule? You can submit comments to CMS until August 31.
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APCs Insider, Issue 31, August 13, 2009
Q: Is there a limit on how frequently patients may receive PET scans, such as 78815 (Tumor...
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APCs Insider, Issue 31, August 13, 2009
No national guidelines for E/M leveling exist, so facilities must develop their own.
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APCs Insider, Issue 30, August 7, 2009
Q. An APC edit states that 93005 (electrocardiogram, routine EKG with at least 12 leads; tracing...
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Briefings on APCs, Issue 8, August 1, 2009
Facilities are failing to meet medical necessity requirements
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Briefings on APCs, Issue 8, August 1, 2009
ICD-9 code changes increase specificity to provide more information.
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Briefings on APCs, Issue 8, August 1, 2009
In this issue, you will find information about the new updates to the ICD-9 codes and look at how...
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APC Payment Insider, Issue 8, August 1, 2009
HIM departments need to establish coding productivity standards.
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APC Payment Insider, Issue 8, August 1, 2009
In this issue we look at six questions you should ask when you evaluate coder productivity...
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APCs Insider, Issue 29, July 31, 2009
Q: What are the guidelines for physician supervision for physical therapy/occupational therapy and...
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APCs Insider, Issue 28, July 24, 2009
Q: I work in a hospital outpatient clinic setting. Has CMS issued a deadline for developing...
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APCs Insider, Issue 28, July 17, 2009
When setting productivity goals, don’t forget to include non-coding responsibilities when...
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HIM-HIPAA Insider, Issue 28, July 14, 2009
Outpatient facilities and pharmacies hoping to see an increase in reimbursement for separately...
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APCs Insider, Issue 27, July 10, 2009
Q: Which CPT code is appropriate for blood glucose monitoring with a device such as...
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APCs Insider, Issue 26, July 3, 2009
Q: My question pertains to CPT code 96376 (therapeutic, prophylactic, or diagnostic injection...
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APC Payment Insider, Issue 7, July 1, 2009
CMS’ decision to broaden coverage of sleep testing for OSA is good news for facilities if...
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APC Payment Insider, Issue 7, July 1, 2009
In this issue we look at CMS’ recent decision to expand coverage of testing for obstructive...
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Briefings on APCs, Issue 7, July 1, 2009
For years, it has been a challenge for healthcare facilities to determine whether Medicare will...
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Briefings on APCs, Issue 7, July 1, 2009
As the current economic climate continues to constrict cash flow for consumers and payers alike...
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Briefings on APCs, Issue 7, July 1, 2009
In this issue, you will find information about how your facility can increase its revenue by...
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APCs Insider, Issue 25, June 26, 2009
Q: How should we report hydration services that run past midnight into the next calendar day along...
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APCs Insider, Issue 25, June 26, 2009
Establishing coding productivity standards is a necessary and challenging aspect of managing an...
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APCs Insider, Issue 24, June 19, 2009
Q: My question pertains to critical care provided in an ER at a Level 1 Trauma Center. If a patient...
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Briefings on APCs, Issue 7, June 12, 2009
Editor’s note: The results of the survey discussed in this article are based on responses...
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Briefings on APCs, Issue 6, June 1, 2009
CMS released its April 2009 quarterly update to the integrated outpatient code editor on March 13.
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Briefings on APCs, Issue 6, June 1, 2009
CMS’ decision to broaden coverage of sleep testing for OSA is good news for facilities if...
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Briefings on APCs, Issue 6, June 1, 2009
With increased ED volume and the demands of more complete documentation, now is the time to...
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Briefings on APCs, Issue 6, June 1, 2009
Inside:
Go electronic to improve compliant charge capture
Strong documentation puts OSA coverage...
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APC Payment Insider, Issue 6, June 1, 2009
CMS discussion of direct supervision requirements likely to spark more questions.
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APC Payment Insider, Issue 6, June 1, 2009
In this issue, we cover CMS’ updated clarifications regarding incident-to services and looks...
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APCs Insider, Issue 21, May 29, 2009
Q: The nurse practitioner (NP) and physician assistant (PA) staff the off-campus clinic with...
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APCs Insider, Issue 20, May 22, 2009
The 2009 OPPS final rule further divided the Q status indicator into three subcategories, with...
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APCs Insider, Issue 19, May 15, 2009
Q: A patient is seen in the ED for laceration repair and then returns for suture or staple removal...
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Briefings on APCs, Issue 5, May 1, 2009
Q. Is it appropriate to assign an IV injection code when facility nursing documentation does not...
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Briefings on APCs, Issue 5, May 1, 2009
Hospitals looking for more discussion about CMS? recent clarification of the direct supervision...
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Briefings on APCs, Issue 5, May 1, 2009
In 2008, CMS greatly expanded the number of packaged items and services payable under the OPPS...
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Briefings on APCs, Issue 5, May 1, 2009
As always, E/M levels must reflect resources consumed, and you still must have written policies and...
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Briefings on APCs, Issue 5, May 1, 2009
Inside:
Solve the twin problems of ED revenue loss and compliance risk
Overcome critical care...
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APC Answer Letter, Issue 5, May 1, 2009
Inside:
Blood procedures: Code correctly when the only service is specimen collection via...
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APC Payment Insider, Issue 5, May 1, 2009
Inside: Watch for changing physician supervision requirements: today’s oversight may be...
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APC Payment Insider, Issue 5, May 1, 2009
Five successive pieces of CMS guidance in the past year have altered the landscape...
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APC Payment Insider, Issue 5, May 1, 2009
CMS has partnered with the Agency for Healthcare Research and Quality (AHRQ) to commission a review...
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APCs Insider, Issue 18, May 1, 2009
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APCs Insider, Issue 18, May 1, 2009
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APC Answer Letter, Issue 4, April 1, 2009
Inside:
Charging for multiple ventricular leads
Quick coding quiz
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Briefings on APCs, Issue 4, April 1, 2009
It's often difficult for coders and providers to determine when it's appropriate to append modifier...
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Briefings on APCs, Issue 4, April 1, 2009
The departure of modifier -21 (prolonged E/M services), effective with the 2009 CPT Manual, isn't...
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Briefings on APCs, Issue 4, April 1, 2009
CMS has partnered with the Agency for Healthcare Research and Quality (AHRQ) to commission a review...
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Briefings on APCs, Issue 4, April 1, 2009
Five successive pieces of CMS guidance in the past year have altered the landscape. They are...
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APC Payment Insider, Issue 4, April 1, 2009
Inside: Control charge compression by knowing your costs, because consumer reaction may cost you...
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APC Payment Insider, Issue 4, April 1, 2009
Charge compression is a complex, long-standing problem. And although CMS is only now recognizing...
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APC Payment Insider, Issue 4, April 1, 2009
Assuming you meet all other documentation and trauma status criteria, you may report the trauma...
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APC Payment Insider, Issue 4, April 1, 2009
Coding and billing for hospital supplies can be confusing because of the complicated terminology...
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APC Payment Insider, Issue 3, March 27, 2009
This is the second of two articles on this year?s CPT changes, effective January 1. Part two covers...
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APC Answer Letter, Issue 3, March 1, 2009
Inside:
DME licenses
Giving supplies away? Here’s how to become a supplier
Nonchemotherapy...
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APC Payment Insider, Issue 3, March 1, 2009
Inside: CMS opens the door to outpatient HAC program CPT checkup: Review the major changes for...
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APC Payment Insider, Issue 3, March 1, 2009
At a December 18, 2008, listening session, CMS presenters discussed possibilities for extending the...
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APCs Insider, Issue 1, January 2, 2009
CPT coders face a lengthy list of changes for 2009. According to the American Academy of...
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Briefings on APCs, Issue 1, January 1, 2009
New composite APCs, continued emphasis on efficiency, and revised definitions for new and...
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APC Answer Letter, Issue 1, January 1, 2009
Inside:
Blood draw via hep lock
Cardiac catheterization: LIMA visualization
Fluoroscopy for...
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APCs Insider, Issue 52, December 26, 2008
How to submit facility critical care claims for 2009
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APCs Insider, Issue 48, November 21, 2008
In general, consider a belladona and opium (B&O) suppository as a self-administered drug, and...
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APCs Insider, Issue 47, November 14, 2008
You may report EKGs performed before or after cardiac catheterization with modifier -59. You cannot...
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Briefings on APCs, Issue 11, November 1, 2008
CMS has proposed to create four new APCs for Type B ED visits in the 2009 OPPS proposed rule, based...
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Briefings on APCs, Issue 11, November 1, 2008
Differentiate transfers, flaps, and grafting procedures, and make use of new codes and any trick to...
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Briefings on APCs, Issue 11, November 1, 2008
This is the first article in a two-part series. It provides the legal background of...
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APCs Insider, Issue 44, October 31, 2008
Opinions on proposed payment changes to type B EDs vary
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Briefings on APCs, Issue 10, October 1, 2008
On June 18, CMS issued MLN Matters article SE0821, a reminder that Medicare pays for diabetes...
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Briefings on APCs, Issue 10, October 1, 2008
Editor’s note: Susan Garrison, CHCA, PCS, FCS, CPC, CPC-H, CCS-P, CHC, CPAR, executive vice...
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Briefings on APCs, Issue 10, October 1, 2008
Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, C-CDIS says without changing the way that...
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Briefings on APCs, Issue 9, September 1, 2008
Inside: CMS proposes five new composite APCs, reduces drug reimbursement; Avoid encoder traps...
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APCs Insider, Issue 20, May 16, 2008
We are negotiating to provide pain stimulator services. We will report code 63650 for the trial and...
