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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 4, January 27, 2012

• Tip: Set rates that reflect intent of new codes

  CMS expects hospital charges to reflect the relative resources that are required to provide a...

• Pay-per-view: Code and guideline changes spread throughout surgery subsections

  In total, the AMA added 60 new codes throughout the surgery section of the 2012 CPT® Manual, 18...

Issue 21, May 25, 2012

• Q/A: Volume requirement for reporting hydration services

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• Tip: Coding for osteoporosis and fractures in ICD-10-CM

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• Pay-per-view: Catch up on what’s new with injections and infusions

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• Trivia

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Issue 20, May 18, 2012

• Q/A: Coding infusions to correct low potassium levels

  Q. Can you help resolve an ongoing debate in our department?   Patients come to our ED and...

• Tip: Look for specific fracture sites when assigning ICD-10-CM codes

  Coders will need more detailed information to assign ICD-10-CM fractures. Coders will need to know...

• Pay-per-view: Compare ICD-9-CM, ICD-10-CM coding for spinal conditions

  Spinal conditions can be congenital, pathologic, or traumatic, and they can affect the vertebrae...

• Trivia

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

Issue 19, May 11, 2012

• Q/A: Payment for HCPCS code J2354

  Q: We don’t understand why our MAC is denying HCPCS code J2354 (injection, octreotide...

• Tip: Distinguish between routine, non-routine nursing supplies

  Not everything kept in stock for nursing floors is a routine item. Bulk items, such as alcohol...

• Pay-per-view: Fracture coding in ICD-10-CM requires greater specificity

  A 25-year-old woman presents to the ED for an initial visit for treatment of open displaced tibia...

• Trivia

  What is the chemical symbol for gold?

Issue 18, May 4, 2012

• Q/A: Bilateral code changes

  Q: Did CMS revise the list of bilateral codes in the OPPS April update?

• Tip: Distinguish traumatic, pathologic fractures in ICD-10-CM

  Coders will need additional details to code fractures with ICD-10-CM. For example, providers must...

• Pay-per-view: Catch up on what’s new with injections and infusions

  Poor documentation and a lack of clear guidance continue to cause coders to struggle with reporting...

• Trivia

  Paul David Hewson is better known as which singer?

Issue 17, April 27, 2012

• Q/A: Appropriate reporting of IVP followed by infusion of the same drug

  Q: We give a loading dose of a drug via IV push before we start an infusion. May we report this...

• Tip: Note ICD-9-CM, ICD-10-CM similarities

  Coders and other HIM professionals generally focus on how  ICD-9-CM and ICD-10-CM...

• Pay-per-view: Determine when to charge inpatient supplies separately

  Coders and billers may not completely understand how to charge for inpatient supplies. One...

• Trivia

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Issue 16, April 20, 2012

• Q/A: Payment for items in OPPS Addendum B

  Q: Why is our MAC denying payment for certain items that have a payment amount listed in OPPS...

• Tip: Note ICD-10-CM diabetes code changes

  ICD-10-CM diabetes mellitus codes are combination codes that include the following information...

• Pay-per-view: ICD-10-CM coding: Start with the structure

  The transition to ICD-10-CM is coming, even though it may be delayed until October 1, 2014. Despite...

• Trivia

  Who was the only U.S. senator from a Confederate state to remain in Congress after secession?

Issue 15, April 13, 2012

• Q/A: Payment for skin substitutes

  Q: We do not always receive payment for skin substitutes that we report. They appear in Addendum...

• Tip: Get to know the ICD-10-CM placeholder

  Not every ICD-10-CM code with a seventh character has a sixth character—or even a fifth or...

• News: HHS proposes one-year delay of ICD-10-CM/PCS

  HHS released a proposed rule April 9 announcing a one-year delay of the implementation of...

• Trivia

  Disney’s Princess Jasmine shares her name with a plant from which family?

Issue 14, April 6, 2012

• Q/A: Billing for HCPCS code C9291

  Q: We recently read Transmittal 2814 for the April OPPS update. Our question pertains to HCPCS code...

Issue 13, March 30, 2012

• Q/A: CMS announces new HCPCS codes effective April 1

  Q: Did CMS establish any new HCPCS codes in the April update to OPPS?

• Tip: Note codes that require two devices to bypass edit

  Codes 0238T (transluminal peripheral atherectomy, including radiological supervision and...

• Pay-per-view: Determine when to charge inpatient supplies separately

  Coders and billers may not completely understand how to charge for inpatient supplies. One...

• Trivia

  The wild prairie rose is the state flower of which of the United States?

Issue 12, March 23, 2012

• Q/A: Provenge® payment problems persist

  Q: We continue to receive no payment for administering the drug Provenge®, CMS had said that...

• Tip: Note new edits in I/OCE

  CMS has added two new edits to the Integrated Outpatient Code Editor (I/OCE) as part of the January...

• Tip: Determine what your room rate includes

  Before deciding which ancillary bedside services can be billed separately to inpatients, facilities...

• Pay-per-view: Take a trip through the digestive system

  The digestive system consists of two parts, the alimentary canal and the accessory organs. The...

• Trivia

  Who is the youngest of the literary Brontë sisters?

• Trivia

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Issue 11, March 16, 2012

• Q/A: Assigning modifier -52 for cancelled procedures

  Q: Our radiology department has begun billing for cancelled diagnostic procedures. For example, a...

• Tip: Respiratory coding guidelines similar in ICD-9-CM, ICD-10-CM

  Coders need to understand the intimate details of the upper and lower respiratory systems to report...

• Pay-per-view: CMS adds new modifier -PD, two edits, additional APCs

  Modifier -PD (diagnostic or related nondiagnostic item or service provided in a wholly owned or...

• Trivia

  According to legend, which animal did Saint Patrick drive out of Ireland?

Issue 10, March 9, 2012

• Q/A: Reporting vaccine administration codes

  Q: We have been reporting the CPT® code for vaccine administration (90471) when administering...

• Tip: Differentiate integral, non-integral self-administered drugs

  In 2002, CMS provided specific guidelines for understanding which self-administered drugs are...

• Pay-per-view: ICD-10 anatomy refresher: Respiratory system

  The respiratory system, responsible for inspiration (carrying oxygen into the body) and expiration...

• Trivia

  Which of the following mammals lays eggs?

Issue 9, February 24, 2012

• Q/A: Reporting HCPCS codes for drugs

  Q. Our chief financial officer wants us to restructure our pharmacy chargemaster to report HCPCS...

• Tip: Determine whether code is time-based when calculating carve-out time

  If a patient receives a therapeutic service that requires active monitoring, coders must carve that...

• Pay-per-view: Code and guideline changes appear throughout surgery subsections

  In total, the AMA added 60 new codes throughout the surgery section of the 2012 CPT® Manual, 18...

• Trivia

  Who received the Oscar for best actor in 1993?

Issue 8, March 2, 2012

• Q/A: Drug administration services that cross midnight

  Q: The AMA issued new CPT® drug administration services guidelines for reporting an initial...

• Tip: Note new guidelines for molecular pathology codes

  Molecular pathology procedures are laboratory procedures that analyze nucleic acid to detect...

• Pay-per-view: Correctly bill ancillary bedside procedures in addition to room rate

  As technology evolves, providers can perform more procedures at the patient's bedside than they...

• Trivia

  Who was the first U.S. President born west of the Mississippi River?

Issue 7, February 17, 2012

• Q/A: New composites for 2012

  Q. What new composites, if any, did CMS create for 2012?

• Tip: Note integumentary system code changes

  The integumentary system subsection of the 2012 CPT® Manual includes nine new codes, 26 deleted...

• Pay-per-view: Defining 'integral' challenging for self-administered drugs

  Self-administered drugs present a significant issue for coders, especially when considering how...

• Trivia

  What is a leprechaun’s traditional occupation?

Issue 6, February 10, 2012

• Q/A: Coding for telescopic intraocular lens

  Q: An ophthalmologist implanted a telescopic intraocular lens (C1840) that is supposed to be...

• Tip: ICD-10-CM simplifies meaning of excludes notes

  ICD-9-CM contains one type of excludes note with two possible meanings. Nothing in the ICD-9-CM...

• Pay-per-view: Code and guideline changes spread throughout surgery subsections

  In total, the AMA added 60 new codes throughout the surgery section of the 2012 CPT® Manual, 18...

• Trivia

  Mesa Verde National Park is located in which U.S. state?

Issue 5, February 3, 2012

• Q/A: New device pass-through categories

  Q: Will CMS ever approve any new device pass-through categories?

• Tip: Note physician supervision changes

  CMS finalized two significant changes to the physician supervision requirements as part of the 2012...

• Pay-per-view: Note major updates to pathology and laboratory section

  Coders can find the largest number of new codes in the pathology and laboratory section of the 2012...

• Trivia

  In the 115 years for which records are available, how many times has Punxsutawney Phil predicted an...

Issue 4, January 27, 2012

• Q/A: Reporting negative pressure therapy

   Q: The new guidelines for the integumentary system section state that CPT® codes...

• Trivia

  The oldest known valentine still in existence today was sent in which year?

Issue 3, January 20, 2012

• Q/A: Reporting molecular pathology codes

  Q: Addendum B of the APC updates for 2012 lists the new molecular pathology codes as status...

• Tip: Corrrectly code image-guided lumbar decompression

  Percutaneous image-guided, minimally invasive lumbar decompression witha specially designed toolkit...

• CMS finalizes numerous provider-friendly OPPS changes for CY 2012

  Fortunately for providers, CMS decided not to cap outpatient payment rates for cardiac...

• Trivia

  Which U.S. state’s motto is Sic semper tyrannis (Thus always to tyrants)?

Issue 2, January 13, 2012

• Q/A: Correct use of modifier -FB and -FC

  Q: Our billing office is concerned about reports that the OIG is auditing for appropriate use of...

• Tip: Take note of inpatient-only list revisions

  CMS removed 10 codes from the inpatient-only list as part of the 2012 OPPS Final Rule. For CY 2012...

• Pay-per-view: Reevaluate charge setting in light of 2012 OPPS final rule

  Hospitals received a timely reminder about the importance of properly setting charges in CMS' 2012...

• Trivia

  What is fear of Friday the 13th called?

Issue 1, January 6, 2012

• Q/A: National Correct Coding Initiative edits

  Q: What advice can you offer providers with respect to 2012 OPPS and National Correct Coding...

• Tip: Understand the three-day rule

  The three-day rule bundles certain outpatient preadmission services into the inpatient MS-DRG...

• Pay-per-view: CMS finalizes numerous provider-friendly OPPS changes for CY 2012

  Fortunately for providers, CMS decided not to cap outpatient payment rates for cardiac...

• Trivia

  In Greek mythology, who is the god of fire?