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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 30, 2005

• Report C8950 twice for separate encounter or separate IV site

  QUESTION: Can our hospital report new drug administration code C8950 (IV infusion for...

Issue 49, December 23, 2005

• Bill E/M level and 36540 for drawing blood from venous access device

  Bill E/M level and 36540 for drawing blood from venous access device QUESTION: How do we bill...

Issue 48, December 16, 2005

• Do not bill E/M level and critical care charge for ED patient

  QUESTION: We would like clarification regarding when we can bill critical care charges to emergency...

Issue 47, December 9, 2005

• Bill 94760-59, 82803 for ED visit

  QUESTION: If a physician orders a noninvasive ear pulse oximetry procedure (94760) during an...

Issue 46, December 2, 2005

• Bill PTCA with modifier -74 for discontinued procedure

  QUESTION: A patient presents for a diagnostic left heart catheterization. While the patient is...

Issue 45, November 18, 2005

• Assign 12001 for simple wound repair with chemical cautery

  Assign 12001 for simple wound repair with chemical cautery

Issue 44, November 11, 2005

• Develop a consistent policy and procedure for reporting cath lab supplies

  QUESTION: For diagnostic procedures performed in the catheter lab, should I bundle the diagnostic...

Issue 43, November 10, 2005

• Report additional services separately for a knee effusion procedure

  QUESTION: A patient comes to the ED with knee effusion. The ED physician aspirates the joint...

Issue 42, October 28, 2005

• Do not separately report pain injections at the conclusion of an operation

  Do not separately report pain injections at the conclusion of an operation

Issue 39, October 7, 2005

• Report medically necessary injections, infusions separately in a PACU setting

  QUESTION: I have a question related to the September 9, 2005, APCs Weekly Monitor article on...

Issue 38, September 30, 2005

• Charge and bill Medicare all pre-operative diagnostic tests

  QUESTION: Can our facility charge for pre-op testing by hospital staff 10 days prior to the...

Issue 37, September 23, 2005

• Do not append modifier -25 to a drug administration claim for a patient with a p

  Is it appropriate to append modifier -25 to an E/M level in conjunction with the administration...

Issue 36, September 16, 2005

• Prepare for October OPPS OCE update

  QUESTION: I have heard that the October OPPS OCE (outpatient code editor) is out and that it...

Issue 35, September 9, 2005

• Follow these guidelines when developing a PACU policy and procedure

  Follow these guidelines when developing a PACU policy and procedure

Issue 34, September 1, 2005

• Providers should comment on the 2006 OPPS proposed rule

  The 2006 APC fee schedule is available on the Internet, but it is a proposed fee schedule. We hear...

Issue 33, August 26, 2005

• Append modifier -74 to cancelled procedures after anesthesia

  QUESTION: If a provider decides to cancel an outpatient surgery, what charges can the hospital...

Issue 32, August 19, 2005

• Submit an inpatient claim for an outpatient admitted to acute care

  QUESTION: If a patient requires admission on the same day following outpatient chemotherapy, should...

Issue 31, August 12, 2005

• How to report ultrasound with ultrasound guided biopsy of thyroid

  QUESTION: I am looking for clarification on the following scenario: A patient presents with two...

Issue 30, August 5, 2005

• Diagnostic v. screening mammogram based on referring physician’s order

  QUESTION: When a non-symptomatic mammography patient has a previous history of breast cancer, do...

Issue 29, July 22, 2005

• Bill single unit of 90788 for split dose

  QUESTION: If a physician orders an intramuscular injection of Gentamycin (160 mg), and one of our...

• Do not append modifier -52 to procedures involving equipment failure

  QUESTION: I have a question regarding equipment failure. A sleep study test is stopped due to...

Issue 28, July 15, 2005

• Bill separately when replacing leads

  QUESTION: A physician placed a pacer and leads in a patient, but the patient had to come back to...

Issue 27, July 7, 2005

• Clarifying status indicator ’S’ and ’T’ procedures

  We have a question about Medicare status indicators and procedure discounting. If a claim contains...

Issue 26, July 1, 2005

• Charge diagnostic mammogram for patient with history of cancer

  When a non-symptomatic mammography patient has a previous history of breast cancer, do you charge...

Issue 25, June 24, 2005

• Facilities may report procedures and critical care codes separately

  An outside company codes all of our ED claims. However, when the company codes our facility’s...

Issue 24, June 17, 2005

• Do not include 73140 in E/M point system

  QUESTION: We are a hospital-based urgent care clinic. Our nurses have their imaging tech licenses...

Issue 23, June 10, 2005

• Bill 70470 for CT scan without, then with contrast

  Q: Our facility performs a CT scan of the head without contrast (CPT 70450) on a patient, then...

Issue 22, June 3, 2005

• Report burn treatment, E/M codes separately

  QUESTION: The nurses in our emergency department apply the dressings for burn treatment. Is it...

Issue 21, May 27, 2005 - VIEW THE FULL ISSUE

Issue 20, May 20, 2005

• Advice for billing inpatient admission in error

  Are any services billable when they’re rendered during an admission deemed by hospital...

Issue 19, May 13, 2005

• New CMS Transmittal 557 updates drug administration

  Do you expect any forthcoming guidance on our unanswered questions from CMS Transmittal 404...

Issue 18, May 6, 2005

• Set your OR facility fee with these staffing guidelines

  QUESTION: We have encountered a couple of hospitals that bill operating room (OR) rates based on...

Issue 17, April 29, 2005

• Advice for billing brand-name v. generic drugs

  QUESTION: How do I bill for a brand-name drug v. a generic drug? Do you have any suggestions for...

Issue 16, April 27, 2005

• Report codes 43235, 91035 for gastrointestinal endoscopy

  (Note: The APCs Weekly Monitor of March 22, 2005, included deleted CPT code 91033. Effective...

Issue 15, April 15, 2005

• Facilities may report G0364 for bone marrow aspiration

  QUESTION: Could you please provide an update regarding HCPCS code G0364 (Bone marrow aspiration...

Issue 14, April 8, 2005

• Do not report G codes for prostate brachytherapy procedures

  Recently we discovered that we were not being paid for our prostate brachytherapy procedures since...

Issue 13, April 1, 2005

• Modifier -27 back in service

  Question: My understanding is that modifier -27 is deleted for 2005 OPPS. Is that true?

Issue 11, March 18, 2005

• How to bill separately for nebulizer treatments

  Question: If our ED nursing staff performs nebulizer treatments, may they be billed separately, or...

Issue 10, March 11, 2005

• Use condition code 44 to change patient status

  Question: Could you please answer a question for our facility regarding change of status of...

• Do not separately bill routine observation services to Medicare

  Do not separately bill routine observation services to Medicare

Issue 9, March 4, 2005

• Report and code all packaged ED services

  QUESTION: Our facility has a question concerning Foley catheters and straight catheterizations for...

Issue 8, February 25, 2005

• Clarifying casting and strapping

  Question: Coders at our facility continue to struggle with the definitions of strapping and...

Issue 7, February 18, 2005

• Hospitals now eligible to bill self-administered drugs

  Question: The Medicare Prescription Drug Benefit Final Rule was published in the January 28, 2005...

Issue 6, February 11, 2005

• Clarifying drug administration with modifier -59

  Today's topic is not a Q/A, but clarifies some confusion about the new CPT infusion codes 90780 and...

Issue 5, February 4, 2005

• Conscious sedation now covered under anesthesia

  Q: Our facility heard about a new CMS transmittal that says conscious sedation is now covered under...

Issue 4, January 28, 2005

• Facilities may create standing order for chiropractic x-ray

  Question: Medicare recently published a Medlearn Matters article which stated chiropractors are not...

Issue 3, January 21, 2005

• Self-administered drugs excluded from Medicare coverage

  Self-administered medications are statutorily excluded from coverage for Medicare beneficiaries...

Issue 2, January 14, 2005

• Billing guidance for infusion therapy codes 90780, 90781

  Our facility has two questions on how to bill for infusion therapy:

Issue 1, January 7, 2005

• Code laceration repair and splint code together

  Q: How do you code a case that involves a patient who goes to the ED for a laceration repair at the...

Issue 30, July 28, 2005

• New camera-in-a-pill could ease pain of endoscopies

  A new pill could change the approach doctors take to performing endoscopies and make their...

Issue 41, October 3, 2005

• How does CMS define the intent of item W3, pneumococcal immunization?

  According to the August 2005 revisions to the updated Resident Assessment Instrument User's Manual...