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APCs Weekly Monitor

This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations. Topics include the outpatient code editor (OCE), complex coding issues, beneficiary co-payment discounting, and cross-department APCs tracking.

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APCs Weekly Monitor

Issue 26, July 3, 2009

• Q/A: Appropriate use of code 96376

  Q: My question pertains to CPT code 96376 (therapeutic, prophylactic, or diagnostic injection...

• Tip: Carefully review CMS' national coverage anaylsis on PET scans

  Until now hospitals had difficulty determining if and when Medicare would cover PET scans for...

• Set the bar with outpatient coding productivity standards

  Establishing coding productivity standards is a necessary and challenging part of managing an...

• Trivia

  Where is the Fountain of the Four Rivers located?

Issue 25, June 26, 2009

• Q/A: Hydration services continuing past midnight

  Q: How should we report hydration services that run past midnight into the next calendar day along...

• Tip: Don't forget to monitor coding productivity standards

  Establishing coding productivity standards is a necessary and challenging aspect of managing an...

• Inpatient ancillary services: Are your costs covered?

  As the current economic climate continues to constrict cash flow for consumers and payers alike...

• Trivia

  Which king created the Step Pyramid, the first great stone complex in Egypt?

Issue 24, June 19, 2009

• Q/A: Critical care coding

  Q: My question pertains to critical care provided in an ER at a Level 1 Trauma Center. If a patient...

• Tip: Criteria for condition code 44

  Condition code 44, “inpatient admission changed to outpatient,” allows hospitals to...

• Perspectives on chronic left ventricular heart failure

  Selecting a code for a patient with heart failure was fairly straightforward; fewer codes existed...

• Trivia

  What is another term for a bunion?

Issue 23, June 12, 2009

• Q/A: CPT code 97760 and L-codes

  Q:  Please clarify the overlap between CPT code 97760 and the L-code. Precisely, when and...

• Tip: Base code on patient?s initial symptoms for undetermined diagnosis

  When a physician is unable to determine a diagnosis at the time of the visit, coders should rely on...

• Tip: Base code on patient’s initial symptoms for undetermined diagnosis

  When a physician is unable to determine a diagnosis at the time of the visit, coders should rely on...

• Medicare: No coverage for virtual colonoscopy screening

  CMS published “Proposed Decision Memo for Screening Computed Tomography Colonography (CTC...

• Trivia

   The procedure to remove the posterior arch of a vertebra is called:

Issue 22, June 5, 2009

• Q/A: Proper assignment of code 99211

  Q: Can we bill 99211 for nursing services provided in a clinic when no physician is present in the...

• Tip: Document medical necessity for sleep tests

  In March, CMS issued a decision memo broadening coverage of sleep testing for obstructive sleep...

• Go electronic to improve compliant charge capture

  With increased ED volume, a government push toward wired solutions, and the demands of more...

• Trivia

  Who was the first person to serve as U.S. ambassador to the United Nations?  

Issue 21, May 29, 2009

• Q/A: Physician supervision requirements for outpatient facility

  Q: The nurse practitioner (NP) and physician assistant (PA) staff the off-campus clinic with...

• Tip: Avoid injection and infusion pitfalls

  Infusions, injections, and vaccine administration continue to represent a compliance risk from...

• Strong documentation puts OSA coverage trouble to sleep

  CMS’ March 3 decision memo that broadens coverage of sleep testing for obstructive sleep...

• Trivia

  Where can you find Alexander Graham Bell’s large box telephone, a Stroh violin, Barbie...

Issue 20, May 22, 2009

• Q/A: Billing for DME

  Q: What if your hospital doesn’t have a DME license? Do you still use only the L codes?

• Tip: Understand Q status indicator subcategories

  The 2009 OPPS final rule further divided the Q status indicator into three subcategories, with...

• CMS releases April I/OCE update

  CMS released its April quarterly update to the I/OCE March 13, effective April 6 (“April 2009...

• Trivia

  The vestibule of the mouth includes:

Issue 19, May 15, 2009

• Q/A: Global payment structure and scheduled ED visits

  Q: A patient is seen in the ED for laceration repair and then returns for suture or staple removal...

• Tip: Ensure consistent application of charges

  Many facilities still lack written and tested policies and procedures to ensure consistent...

• Conform to the new CMS physician supervision requirements

  Hospitals seeking further discussion about CMS’ clarification of physician supervision...

• Trivia

  TURP is an abbreviation for:

Issue 18, May 1, 2009

• Q/A: Billing for CPT Code 86022

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• Q/A: Medically Unlikely Edits

  Q. Why would we receive a Medicare edit for code 96361 (IV infusion hydration each additional hour...

• Conform to the new CMS physician supervision requirements

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• Tip: Use flow sheets for critical care

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• Tip: Q Status Indicators

  The Q status indicators are temporary. When the OCE receives a claim for processing, it will...

• Solve the twin problems of ED revenue loss and compliance risk

  Although the 2009 OPPS final rule didn’t introduce any major changes, EDs still face a host...

• New white paper details E/M auditing

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• Trivia

  The suffix “orrhaphy” means:

• Trivia

  The suffix “orrhaphy” means:

• Trivia

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• Clarification

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Issue 17, April 24, 2009

• Q&A: Coding and billing prosthetics and orthotics

  In a physical therapy department, would it be appropriate to also bill CPT code 97760  in...

• HIPAA survey

  We want to hear from business associates about their need for HIPAA training.  

• Injection and infusion white paper available

  The HCPro Revenue Cycle Institute has released a white paper on injection and infusion coding and...

• Trivia

  Spring trivia

Issue 16, April 17, 2009

• QA:Coding multiple initial infusions

  How you report what appear to be multiple initial scenarios depends on the documentation in the...

• Tip of the week

  Everyone knows that an immense amount of teamwork is necessary for a CDI program to truly be...

• Championing the compliance cause

  Christina Benjamin, MA, RHIA, CCS, CCS-P, presents several compliance traps that coders should...

• Trivia

  Trivia: Thomas Jefferson, gardener

Issue 15, April 10, 2009

• Quarterly OPPS update has important supply billing changes

  Changes in the second quarter OPPS update mean that orthotics and prosthetics, usually with HCPCS...

• CMS announces new publication and FAQs for ICD-10 mappings

  CMS announced on April 6 that a new Medicare Learning Network publication, General Equivalence...

• Countdown to ICD-10

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• Trivia

  April trivia: Boston marathon

Issue 14, April 3, 2009

• CMS has reformulated payments for some bilateral procedures

  An increase in the Medicare payment for bilateral procedures with a status indicator of T slipped...

• Clearly document when sepsis or SIRS is POA

  Never assume that sepsis is present on admission (POA). Sepsis or severe sepsis may be present on...

• Red Flags Rules deadline is May 1

  Medical identity theft is an ugly reality for healthcare organizations, patients, and payers. It's...

• Trivia

  Baseball  trivia

Issue 13, March 27, 2009

• Q/A. One injection code or two?

  When to code multiple injections as one dose.

• Tip of the week

  Recovery audit contractors (RAC) cannot randomly select or target a claim "solely because it...

• CMS reviews negative pressure wound therapy devices

  CMS has partnered with the Agency for Healthcare Research and Quality (AHRQ) to commission a review...

• Trivia

  Birthday trivia

Issue 12, March 20, 2009

• Don’t use modifier -59 for E/M codes

  Don't use modifier -59 (distinct procedural service) for E/M codes. Choose other modifiers...

• Tip of the week

  Effective January 1, 2009, the CCI edits for E/M, including critical care, apply to hospitals. CMS...

• Watch for changing physician supervision requirements

  Watch for changing physician supervision requirements

• Trivia

  Basketball trivia

Issue 11, March 13, 2009

• Q&A. Separate reporting of infusions before and after CPR

  The NCCI manual instructions state that: Procedures routinely performed as part of a comprehensive...

• Hospitals to report ZIP codes of outpatient service locations

  CMS requires providers to report the ZIP code for off-site outpatient facilities. Effective July 6...

• Joint Commission makes changes to maintain deeming authority

  by Jean S. Clark, RHIA It seems as though we can never stay ahead of the curve with respect to...

• Trivia

  More Friday the 13th trivia

Issue 10, March 6, 2009

• While patient education alone isn't an E/M service, the technical component can be

  Education alone is not a separate E/M service. However, it is customary to establish facility E/M...

• APC panel spring meeting

  When the Advisory Panel on Ambulatory Payment Classification Groups panel (APC panel) holds its...

• 2009 OIG Work Plan highlights compliance concerns

  The OIG's list of Medicaid items is larger than it has been in the past, which means providers need...

• Trivia

  More March Trivia

Issue 9, February 27, 2009

• Avoid modifier -58 in the ED

  It’s hard to think of a situation in which you would use modifier -58 in the ED

• APC Panel holds meeting

  The Advisory Panel on Ambulatory Payment Classification Groups panel (APC panel) met in Baltimore...

• RAC outreach sessions

  With RAC officially underway, hospitals and providers should begin fine-tuning their RAC...

• ICD-10 is effective October 1, 2013

  On January 15, the Department of Health and Human Services (HHS) announced the final rule to...

• Trivia

  March trivia

Issue 8, February 20, 2009

• Charging CPR and injections or infusions with critical care

  Q. Two questions: First, during CPR services, can we charge CPT code 92950  in addition to...

• Medicare announces final coverage policy of bariatric surgery for diabetes

  CMS announced February 12 a clarification of its policy for Medicare coverage of bariatric surgery...

• Cigna bulletin boosts physician documentation

  A December 2008 bulletin from CMS carrier Cigna should add an extra impetus for reluctant...

• Trivia

  Washington's birthday trivia

Issue 7, February 13, 2009

• Q&A: Mutually exclusive procedures, NCCI edits

  When procedures edit for being mutually exclusive or for one procedure being included in the code...

• RACs are back on track

  CMS announced February 6 the permanent RAC program is once again underway as the RAC bid protests...

• Control charge compression

  Charge compression is a complex, long-standing problem. And although CMS is only now recognizing...

• Trivia

  Friday the 13th trivia.

Issue 6, February 6, 2009

• Unlisted CPT codes

  New CMS guidance describes the processes for using unlisted CPT codes.

• Tip: Make HIPAA training fun

  Mandatory HIPAA training usually generates the same excitement as a trip to the dentist. Sure, you...

• Charge compression basics

  Buried in the 2009 OPPS final rule’s 1,800-plus pages is an important discussion of a fiscal...

• Trivia

  Groundhog Day trivia

Issue 5, January 30, 2009

• CPT codes change in CCI edits April 1

  Q&A: Why drug administration CPT codes are not hitting CCI edits.

• Tip: Use newly-available medical identity theft resources

  HHS and the Office of the National Coordinator for Health Information Technology held a one-day...

• CPT: The back of the book

  The Category II and Category III sections of the 2009 CPT Manual have seen many changes for 2009.

• Trivia

  Wintertime trivia

Issue 4, January 23, 2009

• Integral insulin administration

  Injectable drugs integral to outpatient treatment paid under OPPS, even if they are considered to...

• New NCDs on error prevention

  CMS has issued three uniform National Coverage Determinations (NCDs) to clarify never events. The...

• 2009 CPT checkup

  CPT coders face a lengthy list of changes for 2009. There are over 700 changes, according to the...

• Trivia

  Presidential trivia for inauguration week

Issue 3, January 16, 2009

• Q&A: Is older guidance on facility E/M billing still valid?

  Federal Register guidance dating to 2000 still applies to facility E/M billing during the...

• 2009 full payment update

  More than 99 percent of hospitals participating in the Hospital Quality Data Reporting Program will...

• EHR could reshape your department

  It’s every HIM director’s dream—a relatively seamless EHR implementation that...

• Trivia

  Astrology trivia

Issue 2, January 9, 2009

• Billing replacement devices

  Billing for a replacement/new device (C895) provided to a facility at no cost after October 1, 2008...

• The CPT errata list

  The AMA has updated its list of errata to the 2009 CPT Manual.

• 2009 Joint Commission manual changes

  Effective this month, The Joint Commission will roll out new accreditation manuals that you may not...

• Trivia

  Poker trivia

Issue 1, January 2, 2009

• New HCPCS II code set

  Review this list of new HCPCS Level II codes for 2009 and be sure to order your 2009 Level II HCPCS...

• RAC focus areas

  The RAC demonstration project revealed several target areas. HIM directors should focus on these...

• 500-plus CPT changes in 2009

  CPT coders face a lengthy list of changes for 2009. According to the American Academy of...

• Trivia

  TV Trivia