HCPro.com: APC Payment Insider

APC Payment Insider reports on the latest coding and policy changes affecting Medicare outpatient billing under ambulatory payment classifications (APCs). This monthly newsletter offers proven strategies to succeed under CMS's outpatient prospective payment system (OPPS), plus ways to enhance chargemaster maintenance, recruit and retain qualified coders, speed billing turnaround, improve documentation habits, and use modifiers properly.

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May 2008 (Volume 10, Issue 5)	view entire issue

Billing for packaged drugs: Meet coverage requirements
If a drug is listed in OPPS Addendum B with a status indicator N (i.e., packaged), should a hospital bill the drug to Medicare? Not necessarily, says Hugh Aaron, MHA, JD, CPC, CPC-H, senior advisor at HCPro, Inc., in Marblehead, MA. The fact that a drug is listed as packaged in Addendum B does not necessarily mean that Medicare covers it. Rather, a status indicator of N simply means that the drug is packaged for payment purposes if the local Medicare contractor (i.e., an FI or Medicare adminis-trative contractor [MAC]) treats the drug as covered.

Injections and infusions
Use 96416 for prolonged infusion, 96522 for implantable pump or reservoir Q: Which documentation supports coding 96416 instead of 96409 and 96521 when the patient receives 5-FU on a particular day? Our documentation states the start time and then indicates via CADD 46 hours. Should we code 96409 for 5-FU and 96521? Or 96416 and 96521?

Other recently-published articles from APC Payment Insider:

CMS proposes five new composite APCs, reduces drug reimbursement

Prefabricated splint codes: No easy answers

Unraveling the costly inpatient-only procedures puzzle

Implement the new ESA transmittals in your hospital

Infusions

Tune E/M documentation to meet the 2008 guidelines

Medically unlikely edits remain a puzzle to providers

RAC report casts spotlight on wrong-setting errors

RAC report casts spotlight on wrong-patient settings

Injections and infusions

Billing for packaged drugs: Meet coverage requirements

Digest the new mandatory reporting requirements for ESA administration as of April 7

Charge appropriately for radiopharmaceuticals in 2008

CMS publishes shocking FAQ about critical care information on its site

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