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APC Payment Insider reports on the latest coding and policy changes affecting Medicare outpatient billing under ambulatory payment classifications (APCs). This monthly newsletter offers proven strategies to succeed under CMS's outpatient prospective payment system (OPPS), plus ways to enhance chargemaster maintenance, recruit and retain qualified coders, speed billing turnaround, improve documentation habits, and use modifiers properly.

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APC Payment Insider

Issue 11, November 1, 2009 - VIEW THE FULL ISSUE

• Two years later, medically unlike edits still a puzzle

  Given the continuing confusion, what can facilities do to handle MUEs?

• Modifier -59: Reduce risk, receive correct reimbursement

  Learn how to correctly use modifier -59 and when to avoid it.

• This month’s coding Q&A

  Buddy taping and splints Q. Can you provide some guidance with respect to buddy taping and the...

Issue 10, October 1, 2009

• CMS proposes more changes to physician supervision requirements

  Proposed changes to outpatient supervision could be a huge boon.

• Separately payable drugs: New calculation method proposed for 2010 doesn’t equal increased payment

  CMS proposes new methodology to calculate drug APC payment rates.

• Coding Q&A

  Does CPT 36592 pertain to a pre-existing catheter (such as a PICC line) that is available for use...

Issue 9, September 1, 2009 - VIEW THE FULL ISSUE

• New ICD-9-CM codes increase specificity

  ICD-9 code changes increase specificity to provide more information.

• CMS clarifies outpatient ?observation services?

  CMS revised language to clarify outpatient observation services.

• Don?t code stent if lesion not crossed

  Physician can’t cross lesion to place noncoronary stent

• Code intended procedure when not completed

  What should you do if a physician can’t complete the procedure?

• Lack of start, stop times affects code selection

  What should you do if a physician can’t complete the procedure?

• Report drug and administration codes

  Make sure you include CPT and HCPCS codes for drugs

• Report in facility setting only

  Know when to report an IV push of the same substance in ER

• Setting, insurer dictate payment policy

  Is charging a patient for a low level facility visit appropriate?

Issue 8, August 1, 2009 - VIEW THE FULL ISSUE

• Set the bar with outpatient coding productivity standards

  HIM departments need to establish coding productivity standards.

• Lumbar myelogram

  Coding, charging for procedure not performed is inappropriate.

Issue 7, July 1, 2009 - VIEW THE FULL ISSUE

• OSA: Put coverage problems to sleep with detailed documentation

  CMS’ decision to broaden coverage of sleep testing for OSA is good news for facilities if...

Issue 6, June 1, 2009 - VIEW THE FULL ISSUE

• Conform to the new CMS physician supervision requirements

  CMS discussion of direct supervision requirements likely to spark more questions.

Issue 5, May 1, 2009 - VIEW THE FULL ISSUE

• Watch for changing physician supervision requirements

  Five successive pieces of CMS guidance in the past year have altered the landscape...

• CMS reviews negative pressure wound therapy devices

  CMS has partnered with the Agency for Healthcare Research and Quality (AHRQ) to commission a review...

Issue 4, April 1, 2009 - VIEW THE FULL ISSUE

• Control charge compression by knowing your costs

  Charge compression is a complex, long-standing problem. And although CMS is only now recognizing...

• Trauma activation code

  Assuming you meet all other documentation and trauma status criteria, you may report the trauma...

• Clear up confusion regarding coding and billing for hospital supplies: Learn DME types and terminology

  Coding and billing for hospital supplies can be confusing because of the complicated terminology...

Issue 3, March 1, 2009 - VIEW THE FULL ISSUE

• CMS opens the door to outpatient HAC program

  At a December 18, 2008, listening session, CMS presenters discussed possibilities for extending the...

• CPT checkup: Review the major changes for 2009

  This is the second of two articles on this year?s CPT changes, effective January 1. Part two covers...

Issue 2, February 1, 2009 - VIEW THE FULL ISSUE

• Coverage policy revised for bariatric surgery as a diabetes treatment

  CMS announced a proposal November 17, 2008, to clarify its policies about Medicare coverage of...

• New year brings more than 500 CPT changes

  CPT codes face a lengthy list of changes this year. According to the American Academy of...

Issue 1, January 1, 2009 - VIEW THE FULL ISSUE

• Make determinations for self-administered drugs

  Plan for best practices Always remember the problem of self-administered medications is an...

• API 2008 index

  Index of APC Payment Insider for 2008