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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 51, December 29, 2006

• CMS to again pay brachytherapy sources based on cost

  Could you please update me regarding 2007 OPPS payment changes for brachytherapy sources?

Issue 50, December 22, 2006

• CMS assigns "special" designation to six packaged codes

  CMS assigns "special" designation to six packaged codes

Issue 49, December 15, 2006

• Do not report drug administration code for non-therapeutic IV infusion

  QUESTION: A patient presents to the ED with a complaint of a left buttock abscess. While the...

Issue 48, December 8, 2006

• Report 90760 for IV infusion to treat gastroenteritis

  QUESTION: A patient presents to the ED with vomiting and stomach pain. The physician orders 1000 ml...

Issue 47, December 1, 2006

• Report 38221-50 for bilateral bone marrow biopsy

  Report 38221-50 for bilateral bone marrow biopsy QUESTION: If a physician performs a bone...

Issue 46, November 17, 2006

• Report chest tubes based on purpose of insertion

  Report chest tubes based on purpose of insertion

Issue 45, November 10, 2006

• Do not bill lumbar spine CT with abdominal/pelvis CT

  Our staff performed an abdominal/pelvis CT. The physician reviewed the study with the radiologist...

Issue 44, November 3, 2006

• Noridian: Report costs of recovery under revenue code 710

  Nordian Administrative Services LLC, fiscal intermediary (FI) for the states of Alaska, Idaho...

Issue 43, October 27, 2006

• Consider reporting extended recovery time with revenue code 719

  With regards to charging extended recovery time on a nursing unit, Medicare has indicated that...

Issue 42, October 20, 2006

• Do not include 46600 in your E/M leveling system

  Do not include 46600 in your E/M leveling system QUESTION: A question recently came up...

Issue 41, October 13, 2006

• Report one drug administration charge for triple lumen

  If ED staff use a triple lumen to peripherally insert a central catheter (PICC) into a patient, can...

Issue 40, October 6, 2006

• Report 96523 for port flush

  QUESTION: What is the correct code to assign when a Medicare patient presents to the outpatient...

Issue 39, September 29, 2006

• Bill 77290, 77295 separately when provided on different dates of service

  National Correct Coding Initiative (NCCI) edits indicate that we cannot report 77290 (Therapeutic...

Issue 38, September 22, 2006

• Work with your FI to determine drug administration documentation requirements

  QUESTION: Our facility is debating the OPPS injection/infusion billing requirements-specifically...

Issue 37, September 15, 2006

• Keep abreast of new UB-04 claim form changes

  We have heard about possible expansion of ICD-9-CM diagnosis codes for the new UB-04 claim form. Do...

Issue 36, September 8, 2006

• Create documentation guidelines for observation

  Under what circumstances is it appropriate to report outpatient observation services performed in...

Issue 35, September 1, 2006

• Follow these tips to properly report bladder catheter codes

  If a staff member places a Foley catheter, but removes it before the patient leaves the ED, which...

Issue 34, August 25, 2006

• CMS proposes that hospitals must track critical care time

  In the 2007 OPPS proposed rule issued August 8, CMS proposed a time threshold for reporting new...

Issue 33, August 18, 2006

• Report 36550 for declotting by thrombolytic agent

  Report 36550 for declotting by thrombolytic agent

Issue 32, August 11, 2006

• Bill injection and drugs separate from procedure

  One of our facilities wanted further information about the recent APCs Weekly Monitor question...

Issue 31, August 4, 2006

• Append modifier -59 to ED injection with appropriate documentation

  A patient presents to the ED with a finger laceration (883.0). The physician repairs the wound...

Issue 30, July 28, 2006

• Strive to bill all payers the same

  How do you capture department charges for services that are payable by commercial payers, managed...

Issue 29, July 21, 2006

• Code 97602 includes wound assessment

  QUESTION: We recently opened a hospital-based outpatient wound care clinic and I need more...

Issue 28, July 14, 2006

• Use revenue code 719 for overnight stay

  What is the proper revenue code to use for patients who have undergone a status S or T outpatient...

Issue 27, July 7, 2006

• Refer to CMS Claims Manual when assigning revenue codes

  We struggle with how to apply the correct revenue codes for drugs given to observation patients who...

Issue 26, June 30, 2006

• Code tick removal depending on leveling guidelines

  QUESTION: If a patient presents to the ED with a tick bite (with whole or part of the tick still...

Issue 25, June 23, 2006

• Bill facility critical care independent of physician billing

  QUESTION: Are CPT codes 99291 (critical care, evaluation and management of the critically ill or...

Issue 23, June 9, 2006

• Include non-screening pelvic exam in E/M criteria

  QUESTION: A patient presents to the ED with a complaint that requires a manual pelvic exam without...

Issue 22, June 2, 2006

• When to bill an ED E/M facility charge with a procedure

  When to bill an ED E/M facility charge with a procedure

Issue 21, May 26, 2006

• Expect relief from modifier -59 with drug administration claims

  Expect relief from modifier -59 with drug administration claims

Issue 20, May 19, 2006

• Bill canceled procedure separate from performed procedure

  Bill canceled procedure separate from performed procedure

Issue 19, May 12, 2006

• Follow ABN guidelines for noncovered outpatient procedures

  Follow ABN guidelines for noncovered outpatient procedures

Issue 18, May 5, 2006

• When to charge drug administration services

  When to charge drug administration services

Issue 17, April 28, 2006

• Do not report interrogation/reprogramming codes for turning devices on/off

  I have a question regarding the codes for pacemaker and defibrillator device...

Issue 16, April 21, 2006

• Meet criteria to receive APC payment for G0379

  Meet criteria to receive APC payment for G0379

Issue 15, April 14, 2006

• New CMS transmittal clarifies drug administration, modifier -59

  CMS Transmittal 902, dated April 7, 2006, put in writing some of the answers that providers have...

Issue 14, April 7, 2006

• Report sequential infusions with 90767

  Report sequential infusions with 90767

Issue 13, March 31, 2006

• Develop visit charges to bill for "clinic" visits in an ED

  Develop visit charges to bill for "clinic" visits in an ED

Issue 12, March 24, 2006

• Establish nursing documentation standards for new drug administration codes

  Establish nursing documentation standards for new drug administration codes

Issue 11, March 17, 2006

• Consider these strategies to bill non-qualifying inpatient

  Consider these strategies to bill non-qualifying inpatient

Issue 10, March 10, 2006

• Meet proper compliance when dispensing crutches in the ED

  Meet proper compliance when dispensing crutches in the ED

Issue 9, March 3, 2006

• Guidelines to report multiple units of C8950

  Can we bill C8950 incrementally, meaning more than one unit of service per encounter? For example...

Issue 8, February 24, 2006

• Report direct 24-hour observation admit with G0379 x1, G0378 x24

  Bill one unit of G0379 and 24 units of G0378. The one unit of G0379 represents more of an E/M-type...

Issue 7, February 17, 2006

• New CMS guidance places stiff limit on drug administration code

  Hospitals allowed to bill C8952 only once per encounter for same drug

Issue 6, February 10, 2006

• How to bill IV infusion time to Medicare and non-Medicare payers

  How to bill IV infusion time to Medicare and non-Medicare payers

Issue 5, February 4, 2006

• Always bill drug administration with J code

  Always bill drug administration with J code

Issue 4, January 27, 2006

• Use codes C8950, C8951 for Medicare non-chemo infusion

  QUESTION: Regarding the new drug administration codes, if a patient receives a non-chemo infusion...

Issue 3, January 20, 2006

• G0168 rejected by claims scrubber

  G0168 rejected by claims scrubber QUESTION: In the 2005 OPPS final rule, CMS assigned a status...

Issue 2, January 13, 2006

• Guidance for proper use of Category III CPT codes

  QUESTION: I am confused as to when we should report Category III CPT codes. I thought they were...

Issue 1, January 6, 2006

• Bill 94640 and appropriate revenue code for hand-held nebulizer

  QUESTION: How do you charge for a hand-held nebulizer that contains a drug such as Albuterol? A...