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APCs Insider
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.
2013 | 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003 | 2001
APCs Insider
Issue 14, April 12, 2013
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Upcoming CMS events
Upcoming CMS events -
Medicare Updates
Medicare updates
Issue 11, March 15, 2013
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Q/A: When will Medicare recognize CPT code 90661?
Q: We have been providing Flucelvax to non-Medicare patients when prescribed by their...
Issue 24, June 14, 2013
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CMS releases new ICD-10 FAQs
CMS released three FAQs about ICD-10 billing, including how to bill encounters that cross the... -
Q/A: How do we report therapy G codes and modifiers for multiple therapies?
Q: Our outpatient rehab department is having some discussion about how to report the G codes... -
Tip: Start preparing for reimbursement changes under ICD-10
Providers will get good and bad news about reimbursement under ICD-10. The bad news is that... -
Pay-per-view: Shrink radiation oncology coding confusion
Radiation oncology uses high-energy radiation to shrink or kill tumors or cancer cells with minimal... -
Trivia
Devils Lake is the largest natural body of water in which US state? -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events -
Product of the week: Observation Services live audio conference June 25
Product of the week: Observation Services live audio conference June 25
Issue 23, June 7, 2013
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Q/A: Are hospital outpatient therapy departments required to report the new functional G codes and modifiers?
Q: Are hospital outpatient therapy departments required to report the new functional G codes... -
Q/A: Are hospital outpatient therapy departments required to report the new functional G codes and modifiers?
Q: Are hospital outpatient therapy departments required to report the new functional G codes... -
Tip: Know which denials are subject to Part B rebilling ruling
CMS' ruling (CMS-1455-R) released March 13 (published in the Federal Register on March 18), allows... -
Pay-per-view: Check out the view from the industry as ICD-10 implementation draws closer
ICD-10 implementation challenges will vary from organization to organization, depending on size... -
Trivia
Who holds the record for the most personal Grammy awards? -
This week's Medicare updates
This week’s Medicare updates -
Upcoming CMS events
Events include: CMS seeks public comment on proposed PPS-exempt cancer hospital measures...
Issue 22, May 31, 2013
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Dangers of reporting costs improperly
Providers setting charges based on an understanding of their costs is not a new concept, says Jugna... -
Take time to review query forms
When was the last time you updated your physician query forms? This year? Last year? Not since you... -
Q&A: Is CMS now accepting rubber stamp signatures?
Q: One of the physicians who practices here says that CMS is allowing rubber stamp signatures again... -
Tip: Consider using GEMS during ICD-10 transition
General equivalence mappings (GEMs) are reference maps between ICD-9-CM and ICD-10-CM codes. They... -
Pay-per-view: CMS changes Part B inpatient billing in hospitals
Successful appeals can actually lead to CMS policy changes. Facilities have been successfully... -
Trivia
Which amendment to the US Constitution provides the right to a speedy trial? -
Observation Services 2013: Establishing Key Performance Indicators live webcast
Providers often struggle to assess their use of observation services because most performance...
Issue 21, May 24, 2013
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Questions surround when time starts for proposed inpatient presumption
The proposed CMS presumption for inpatient admission includes an interesting nuance that could... -
Q/A: Should we use modifier -Q0 to override edits for ICDs?
Q: We are hitting an edit for claims containing the codes for placement of implantable... -
Tip: Review codes that are now packaged
As part of the April update to the I/OCE, CMS changed the status of the following codes from E (not... -
Pay-per-view: CMS changes Part B inpatient billing in hospitals
Successful appeals can actually lead to CMS policy changes. Facilities have been successfully... -
Trivia
What is the proper term for a flock of crows? -
This week?s Medicare updates
This week’s Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 20, May 17, 2013
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CMS looking for comments on molecular pathology payments
The AMA revamped coding for molecular pathology beginning in 2012 and continuing in the 2013... -
Q/A: How should we report irradiated blood products?
Q: We have patients who have received a lot of blood and now the orders are for irradiated... -
Tip: Keep an eye on evolving molecular pathology codes
Why do some molecular pathology codes clearly list variants as examples, not an exclusive list... -
CMS corrects edit 84, deletes modifiers
CMS corrected edit 84, added five APCs to the I/OCE, deleted two APCs, and changed the description... -
Trivia
Which country’s capital city is alphabetically last? -
Medicare updates
Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 19, May 10, 2013
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Recovery Auditors starting to review outpatient therapy services
Outpatient therapy services furnished between January 1 and December 31, 2013, are subject to a... -
Q/A: Should we report low-level E/M for all infusion patients?
Q: We routinely bill a low level E/M for all patients coming into our infusion clinic. This... -
Provider Roundtable seeks new members
The Provider Roundtable (PRT) was established in 2003 to give CMS the benefit of providers&rsquo... -
Tip: Review guidelines for add-on code for interactive complexity for psychotherapy
The term "interactive complexity" means that the provision of psychiatric services has... -
Pay-per-view: Molecular pathology reimbursement still unclear
The AMA revised the molecular pathology codes in the CPT® Manual in 2012, but at that time CMS... -
Trivia
Which state’s motto is Audemus jura nostra defendere (We dare defend our rights)? -
Medicare updates
Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 18, May 3, 2013
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Observation services under review in IPPS
In last year’s OPPS proposed and final rules, CMS solicited comments about redefining... -
Q/A: Why are we hitting an edit for flushing a line?
Q: We are receiving errors on our scrubber software that we haven’t seen... -
Provider Roundtable seeks new members
The Provider Roundtable (PRT) was established in 2003 to give CMS the benefit of providers&rsquo... -
Tip: Note new HCPCS codes and effective dates
CMS added HCPCS code G0459 (inpatient telehealth pharmacologic management, including prescription... -
Pay-per-view: CMS changes Part B inpatient billing in hospitals
Successful appeals can actually lead to CMS policy changes. Facilities have been successfully... -
Trivia
Which U.S. President changed his name from Leslie Lynch King Jr? -
Trivia
Which U.S. President changed his name from Leslie Lynch King Jr? -
Trivia
Which U.S. President changed his name from Leslie Lynch King Jr? -
Trivia
Which U.S. President changed his name from Leslie Lynch King Jr? -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 17, April 26, 2013
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CMS reaffirms ICD-10 implementation date
October 1, 2014 is the ICD-10 implementation date and CMS is sticking to it. Denise Buenning, MsM... -
Q/A: Can we use an L code to satisfy neurostimulator device edit?
Q: We are using a neurostimulator device that is reportable with HCPCS L8685, but the OCE edits... -
Tip: Check out these reasons to perform coding audits
If the thought of the government recouping your payments (often with interest) isn't enough to... -
Pay-per-view: CMS changing MUEs
CMS is making a significant change to the Medically Unlikely Edits (MUE) by changing some of them... -
Trivia
Who was Time Magazine’s first Man of the Year? -
The week in Medicare updates
The week in Medicare updates -
Upcoming CMS events
Upcoming CMS events
Issue 16, April 19, 2013
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CMS offers additional guidelines for Part A to Part B rebilling
CMS released a ruling and a proposed rule for Part A to Part B rebilling March 13. CMS has since... -
Q&A: Why are we receiving errors for skin substitute HCPCS codes?
Q: We have a wound care center that applies skin substitutes. We have started receiving... -
Tip: Differentiate between abbreviations for molecular pathology coding
One potential source of confusion for coding molecular pathology services involves the... -
Pay-per-view: Audits help lock down processes, clarify coding
Being audited is rarely fun. After all, you're probably going to lose money, face a fine, or both... -
Trivia
How many men made up President George Washington’s cabinet? -
Medicare Updates
The week in Medicare updates -
Upcoming CMS Events
Upcoming CMS Events
Issue 15, April 12, 2013
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Deciding whether to appeal isn't always easy
You submit a claim for what you believe to be medically necessary services for an outpatient... -
Q/A: Did CMS add any codes to the conditionally bilateral list?
Q: Did CMS add any codes to the conditionally bilateral list as part of the April OPPS update? -
Tip: Note new medically unlikely edit categories
CMS recently changed some medically unlikely edits (MUEs) from line-item edits to date-of-service... -
Pay-per-view: New molecular pathology coding still complex
At first glance, the new CPT® codes for reporting molecular pathology services might seem... -
Trivia
Where in the world is Ayers Rock?
Issue 14, April 5, 2013
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CMS reduces payment for single session cobalt-60 based stereotactic radiosurgery
Hospitals reimbursement is declining all the time for a variety of reasons. Facilities may not be... -
Q/A: Did CMS add any new drugs with pass through status in the April OPPS update?
Q: Did CMS add any new drugs with pass through status in the April OPPS update? -
Tip: Review CPT notes for imaging guidance
The AMA included or revised the parenthetical notes following a number of CPT® codes for image... -
Pay-per-view: CMS changing MUEs
CMS is making a significant change to the Medically Unlikely Edits by changing some of them from... -
Trivia
Which U.S. state was the first to pass legislation for a state sales tax? -
Medicare updates
Highlights of the past week’s Medicare updates include changes to the Medicare Physician Fee... -
Upcoming CMS provider calls
CMS will hold three national provider calls in April. Two will be on the Medicare Shared Savings... -
We want to know how you charge for ancillary bedside procedures
We want to know how you charge for ancillary bedside procedures
Issue 13, March 29, 2013
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CMS updates I/OCE edit 84
As part of the April update to the Integrated Outpatient Code Editor (I/OCE), CMS is revising the... -
Q/A: Is CMS reducing payment for CPT code 77371?
Q: We heard that CMS will reduce payment for CPT® code 77371 (radiation treatment delivery... -
Tip: Keep track of new modifiers
CMS added two new modifiers to the anatomical modifiers that may be used under appropriate clinical... -
Pay-per-view: Follow the right path for coding nonvascular interventional radiology
When coders hear the words "interventional radiology," many think of vascular procedures... -
Trivia
When was the first official Easter egg roll held on the White House lawn? -
The week in Medicare updates
The week in Medicare updates -
Medicare Audit Improvement Act reintroduced
On March 19, Congressmen Sam Graves (R-Mo.) and Adam Schiff (D-Calif.) reintroduced the Medicare... -
Outpatient Coding Edits: Learn the Logic Behind the Edits live webcast May 15
Coders routinely use modifiers, especially modifier -59, to override coding edits to ensure their...
Issue 12, March 22, 2013
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Mapping or crosswalking?
Crosswalks are quite in vogue as we prepare for the October 1, 2014 implementation of ICD-10. But... -
Q/A: Has CMS established any new procedure codes for the April OPPS update?
Q: Has CMS established any new procedure codes for the April OPPS update? -
Tip: Keep up with base codes for add-on code 33225
CMS added two codes to the list of primary procedures reportable with add-on code 33225 (insertion... -
Tip: Keep up with base codes for add-on code 33225
CMS added two codes to the list of primary procedures reportable with add-on code 33225 (insertion... -
Pay-per-view: Follow the right path for coding nonvascular interventional radiology
When coders hear the words "interventional radiology," many think of vascular procedures... -
Trivia
Which school has won the most NCAA women’s Division I basketball championships? -
CMS Updates
CMS issues guidance on Part B inpatient billing in hospitals On March 18, CMS issued in the...
Issue 11, March 15, 2013
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CMS issues ruling, proposed rule on Part B rebilling
Successful appeals can actually lead to CMS policy changes. Facilities have been successfully... -
Tip: Check off elements needed for non-vascular interventional radiology code selection
Coders can follow a simple path to choose the correct code for a non-vascular interventional... -
Pay-per-view: AMA revises, deletes radiology codes for 2013
The AMA added five new nuclear medicine codes to the radiology section of the 2013 CPT® Manual... -
Trivia
Which U.S. city was the first to install parking meters?
Issue 10, March 8, 2013
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IV pushes that last more than 15 minutes
A push is a push is a push. If I’ve heard Jugna Shah, MPH, say that once in relation... -
Q&A: What modifier do we use for bilateral diagnostic interventional procedures?
Q: Our physicians perform diagnostic interventional procedures in the head and neck, represented in... -
Tip: Note new thyroid imaging codes
The AMA made numerous revisions to the nuclear medicine and diagnostic endocrine system subsection... -
Trivia
The river that runs through which U.S. city is traditionally died green for St. Patrick’s Day?
Issue 9, March 1, 2013
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Ensure your wound care coding is compliant
HIM managers and coders know that accurate wound care coding starts long before the record hits to... -
Q&A: How should we code fluoroscopy for outpatient procedures?
Q: Our physicians use fluoroscopy for many procedures and we have always reported the... -
Tip: Note new codes for ventricular assist devices
Codes for reporting the insertion of a ventricular assist device (VAD) are not new. However, the... -
Pay-per-view: Ensure correct reporting of place of service code
Physicians and other providers practice in many different areas within a hospital. To... -
Trivia
According to legend, how did St. Patrick make the snakes disappear from Ireland?
Issue 8, February 22, 2013
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Take note of I/OCE edit interactions
The I/OCE edits are full of nuances and exceptions, so it’s important to understand how they... -
Q/A: When do we use modifier -52 with the new electrophysiology ablation codes?
Q: Our cardiac catheter lab performs electrophysiology (EP) studies/ablation procedures, but our... -
Tip: Check out the new flu codes
The AMA added two new CPT® codes for influenza vaccinations for 2013. -
Pay-per-view: AMA introduces neutrality for provider types
One of the major changes to the 2013 CPT Manual is the replacement of the term... -
Trivia
Which individual has been nominated for an Oscar in the most separate categories during his career?
Issue 7, February 15, 2013
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Get the inside scoop on ED coding and modifiers
Coders and billers continue to struggle with appending modifiers -25 (significant, separately... -
Q/A: Can we report cardioversion performed during an ED code?
Q: We’ve just completed our yearly audit and the ED portion was pretty good. We did... -
Tip: Follow guidelines for reporting Interactive complexity
When specific communication factors are present that complicate the delivery of a psychiatric... -
Pay-per-view: New codes for cardiology procedures added to manual
In November 2011, the FDA approved transcatheter aortic valve replacement (TAVR) to treat aortic... -
Trivia
Who was the suspected mastermind of the 1929 St. Valentine’s Day Massacre in Chicago?
Issue 6, February 8, 2013
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Even the Senate is looking at care setting
As part of the 2013 OPPS proposed rule, CMS asked for input on potential clarifications or changes... -
Q&A: Why are multiple port film line items denied?
Q: We received a line item denial for our port films. The documentation in the record supported the... -
Tip: Note new base codes for aortic valve replacement
New CPT® codes are now available to report the provision of a transcatheter aortic... -
Pay-per-view: Note major changes in ¬medicine section
After 14 years of few to no changes, the psychiatry section of the CPT® Manual received a major... -
Trivia
Where was the 1993 film Groundhog Day filmed?
Issue 3, January 18, 2013
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Make sure you review AMA's CPT errata
It turns out that the AMA can’t actually predict the future. On January 9, the AMA sent out a... -
Q&A: Reporting transitional care management codes
Q: Why would a hospital bother to bill the transitional care management (TCM) codes for the visit... -
Tip: Review common services to determine effect to geometric mean
CMS finalized a change to the way it generates APC relative weights: For 2013, the agency will use... -
Pay-per-view: Hospitals see therapy, molecular pathology changes
The biggest operational change for outpatient facilities for 2013 does not appear in the 2013 OPPS... -
Trivia
Phnom Penh is the capital of which country?
Issue 2, January 11, 2013
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Evaluation and management coding concerns continue
In a recent poll on JustCoding, we asked readers to vote on which area of coding gave them the most... -
Q/A: Clarification of new NCCI manual language
Q: Can you clarify what this new language in the National Correct Coding Initiatives (NCCI) manual... -
Tip: Appropriately sequence additional diagnoses
Determining the appropriate order to translate diagnoses into ICD-9 codes on the claim form can be... -
Pay-per-view: CMS packaging clarification could raise problems
As part of the 2013 OPPS final rule, CMS finalized a clarification to 42 CFR 419.2(b) that could... -
Trivia
Which state was the last to secede from the Union during the Civil War and the first to be...
Issue 1, January 4, 2013
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New codes for intracoronary stent placement
Coders now have more choices when it comes to coding an intracoronary stent placement. The AMA... -
Q/A: Addendum B as the basis for coverage
Q: In the 2013 OPPS Addendum B, when we look up a specific CPT® code, it shows status indicator... -
Tip: Assess current documentation before discussing ICD-10 with physicians
Avoid taking too broad an approach when discussing ICD-10 documentation requirements with... -
Pay-per-view: CMS finalizes changes to drug payments, relative weight calculations
Hospitals earned a big win with drug payments this year in the 2013 OPPS final rule, released... -
Trivia
Which of the following is the highest grossing film of 2012? -
January 2013 I/OCE updates available
CMS released the January 2013 updates to the integrated outpatient code editor in Transmittal 2616. -
CMS releases Addendum A and B updates
The January 2013 updates to OPPS Addendum A and B are now available on the CMS website.
Issue 5, February 1, 2013
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Capturing start and stop times for infusions
During Wednesday's audio conference, Injections and Infusions: Review of Drug Administration... -
Q/A: Devices with pass-through status
Q: Are any devices still paid as a pass-through status under OPPS? -
Tip: Note new base codes for aortic valve replacement
New CPT codes are now available to report the provision of a transcatheter aortic valve... -
Pay-per-view: Note major changes in medicine section
After 14 years of few to no changes, the psychiatry section of the CPT Manual received a major... -
Trivia
Where was the 1993 film Groundhog Day filmed?
Issue 4, January 25, 2013
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Time for an injections and infusions checkup
Certain topics in coding seem to be perennial problems even without major coding or regulatory... -
Q&A: Physician supervision for chemotherapy
Q: I have a question about physician supervision for a cancer center that is not in the hospital... -
Tip: Note molecular pathology changes in MPFS
Over the past two years the AMA has made significant additions to the molecular pathology CPT... -
Pay-per-view: Begin teaching providers to speak ICD-10
Providers and coders seem to speak two different languages-clinical and coding. Providers already... -
Trivia
Which U.S. President later served as Chief Justice of the U.S. Supreme Court?
Issue 14, March 8, 2013
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Pay-per-view: Follow the right path for coding nonvascular interventional radiology
When coders hear the words "interventional radiology," many think of vascular procedures...