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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.
2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003 | 2001
APCs Weekly Monitor
Issue 4, January 27, 2012
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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?