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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 50, December 17, 2004

• Guidelines for reporting 91035 same as C9712

  Since C9712 is deleted for 2005 and it appears providers are to report 91035 in its place, should...

Issue 49, December 10, 2004 - VIEW THE FULL ISSUE

Issue 48, December 3, 2004

• In 2005, report venipunctures using 36415

  Q: I noticed that G0001 is a deleted code for 2005. This is the code Medicare has required for...

Issue 47, November 19, 2004

• Use caution when applying modifier -25

  According to CMS Program Memorandum A-01-80, the OCE requires modifier -25 with E/M codes reported...

Issue 46, November 12, 2004

• Report revenue code based on setting

  Q: We are a hospital that frequently provides outpatient services such as injections and infusions...

Issue 45, November 5, 2004

• Do not bill C9713 with 52648

  HCPCS C9713 represents the procedure and therefore supersedes the CPT code. Do not code both...

Issue 43, October 22, 2004

• Injections covered if medically necessary

  Medicare covers injection administrations that are medically necessary. This means that the...

Issue 41, October 8, 2004

• Charge for pacemaker insertion with fluoroscopy

  Question: While in the operating room, a pacemaker insertion is done in conjunction with...

Issue 40, October 1, 2004

• Will Medicare require "C" codes in 2005?

  Beginning in 2005, CMS is proposing to require hospitals to bill device-dependent procedures using...

Issue 39, September 24, 2004

• Do not code 57288 with 52000

  The American Medical Association has a specific policy on this. It would not be appropriate to...

Issue 38, September 17, 2004

• Charge for venipuncture separately

  CMS provides a HCPCS code for collection of a specimen via venipuncture (G0001: routine...

Issue 37, September 9, 2004

• Nostrils are paired body organs

  Is it appropriate to append modifier -50, bilateral procedure, to CPT code 30901, control nasal...

Issue 36, September 3, 2004

• Workers’ comp codes status B

  Workers’ comp codes status B

Issue 35, September 3, 2004

• When to use 36550

  When to use 36550

Issue 34, September 3, 2004

• How to code PICC line declotting

  How to code PICC line declotting

Issue 32, August 5, 2004

• No more grace period for HCPCS

  I heard that Medicare has eliminated the 90-day grace period for Healthcare Common Procedure Coding...

Issue 31, July 29, 2004

• Accurately report HCPCS codes

  I have heard that if we charge less for a service than Medicare reimburses, Medicare will pay us...

Issue 30, July 23, 2004

• Timeframe to adjust a claim

  How long does a hospital have to submit an adjustment claim to Medicare for an Outpatient...

• Timeframe to adjust a claim

  How long does a hospital have to submit an adjustment claim to Medicare for an Outpatient...

Issue 29, July 16, 2004

• Line-item date-of-service reporting

  Is it true that CMS will have new requirements for line-item date-of-service reporting? Where can I...

Issue 28, July 8, 2004

• Outpatient treatment room services

  Outpatient treatment room services

Issue 27, July 1, 2004

• More colonoscopy coding considerations

  What is the appropriate CPT-4 code(s) assignment when a physician performs a colonoscopy by...

Issue 26, June 24, 2004

• Documentation key for E/M plus procedure code

  Documentation key for E/M plus procedure code

Issue 25, June 17, 2004

• More multiple-stent guidance

  How would one code for placement of a drug-eluting stent (DES) in one vessel/branch and placement...

Issue 23, June 4, 2004

• Coding an E/M with other services

  Coding an E/M with other services

Issue 22, May 28, 2004

• Coding an E/M level v. a CPT code

  Coding an E/M level v. a CPT code

Issue 21, May 21, 2004

• Clinic and hospital visit on same date of service

  Clinic and hospital visit on same date of service

Issue 20, May 14, 2004

• Billing scenarios for daily outpatient antibiotics

  Will Medicare cover a discharged patient who needs daily antibiotics for Methicillin Resistant...

Issue 19, May 13, 2004

• Two-times rule defined

  What does it mean when the Federal Register states that something violates the "two-times rule"?

Issue 17, April 23, 2004

• Scheduled care in the ED

  When we have patients coming to the ED for scheduled care, such as IV antibiotics, should the...

Issue 16, April 16, 2004

• CMS update

  Is it true that Medicare will release HCPCS Level II codes for services added to New Technology...

Issue 15, April 12, 2004

• How to use revenue codes with trauma patients

  I need to understand how to correctly use revenue codes in the 068X series for trauma. I think we...

Issue 14, April 5, 2004

• No separate charge for surgery-related IV

  I am looking for specific regulation to clarify whether intraoperative IV antibiotics are...

Issue 13, March 26, 2004

• Proper coding for polyp removal

  When a patient has a colonoscopy with removal of two polyps, both from the sigmoid, both removed by...

Issue 12, March 19, 2004

• 2004 central-access device codes

  We are reviewing the 2004 central-access device codes and need clarification regarding the...

Issue 11, March 11, 2004

• Condition code 44: caution advised

  If a patient was admitted as an inpatient by the physician, but utilization review determined that...

Issue 10, March 5, 2004

• Monitoring integral to surgery

  When a patient is under general anesthesia, a 3-lead electrocardiogram (EKG), CPT 93041 is...

Issue 9, March 3, 2004

• Wound treated with HBO part of procedure

  Can you code both C1300, hyperbaric oxygen (HBO) under pressure, full-body chamber, per 30-minute...

Issue 8, February 23, 2004 - VIEW THE FULL ISSUE

Issue 7, February 23, 2004 - VIEW THE FULL ISSUE

Issue 6, February 6, 2004

• Radiology reports may support medical necessity

  QUESTION: When you have an observation/ambulatory surgery account, can the findings from a...

Issue 5, January 28, 2004

• New codes for CVA procedures

  This week, our experts provide information on two new codes for central venous access (CVA...

Issue 4, January 26, 2004

• Enteryx: what it is and how to code

  This week, our experts explain how to code for Enteryx injection, a new procedure used to treat...

Issue 3, January 26, 2004

• Use C code for new technology IOLs

  This week, our experts explain how to best report cataract surgery with intraocular lens insertion.

Issue 2, January 9, 2004

• CCI diligence is crucial for OPPS

  CCI diligence is crucial for OPPS

Issue 24, June 10, 2004

• Incomplete colonoscopy coding

  Our facility had a Medicare patient come in for a colonoscopy because of family history of colon...