Health Information Management

Using revenue codes, not HCPCS

APCs Insider, January 21, 2003

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January 10, 2003
Vol. 4, No. 1


A year of cooking

We have collected a year's worth of special recipes from our readers that are available to you in four delicious volumes.

Don't forget to download copies of these books from the APC Monitor Cookbook section on our Web site and expand your dinner menu!

Window Shopping Monitor-Style
We've got terrific resources for your APC coding team. Check out our two APC newsletters.

"Briefings on APCs" is a monthly newsletter devoted entirely to managing under APCs, including tips, charts, and advice from the experts.

"APC Answer Letter" is a question and answer publication - readers supply the questions, our experts supply the answers. Click on the links to find out more.




Need to know exactly what Medicare owes? What your patient's co-pay should be? Quickly and electronically? Investigate Info-X's web based solution - APC Precise. For more information, click here or call 800-299-1091.

IRP, Inc.

IRP's CODING SOFTWARE is specifically designed for Medicare APC compliance. Fits ALL platforms and easily integrated with existing applications. Visit our comprehensive APC Reference Library. Click here or call 800-634-0496 x244.


Jugna Shah,
Nimitt Consulting

Cheryl D'Amato,
director health information management
HSS, Inc.

Julie Downey,
ambulatory coding coordinator, HIM
University Colorado Hospital

Carole Gammarino,
professional services consultant
Precyse Solutions

Valerie Rinkle, MPA,
revenue cycle director
Asante Health System

Keith Siddel,
MBA, PhD (c),
HRM, Hospital Resource Management





Headaches: if ice cream doesn't get you, CMS will!

Ever wonder what causes an ice cream headache? According to a cool trivia web site called CoolQuiz Network, the headaches are triggered by the sudden drop in temperature when you eat something cold. The nerve center on the roof of your mouth overreacts to try and heat your brain by causing the swelling of blood vessels in your head.

Although excruciating, the pain that effects 30 percent of us lasts no more than 30 to 60 seconds.

To avoid this trauma from happening to you, keep cold foods or beverages on the side, and away from the roof, of your mouth.

Speaking of headaches, what about the CMS Program Memorandum A-02-129 issued last week?

The 2003 Update of the Hospital Outpatient Prospective Payment System (OPPS) outlines changes in the OPPS for calendar year 2003. These changes were discussed in the OPPS final rule for 2003, published in the Federal Register on November 1, 2002. Most of these changes are effective for services furnished on or after January 1, 2003, and there are lots of them!

To prepare yourself, check out our February APCAL and Briefings newsletters, this Web site and the CMS Web site to stay up to date on the latest changes.

According to the president of our Advisory Board, Jugna Shah, MPH, there are a number of clarifications and new items that providers need to digest as soon as possible.

For example, CMS has finally clearly explained that when reporting one of the new G-codes for the direct admission to observation, providers should NOT report an E/M code. The G0263 and G0264 are to be used in lieu of the E/M codes.

There are other requirements that providers need to read about. In addition, there is other new information related to coding, billing, units of service limits for certain services, and revenue code reporting information related to drugs that graduated from the pass-through payment list.

Don't let the new PM give you a headache! Stay tuned to next month's Briefings on APCs, which will cover a number of these topics.

Your "APC Weekly Monitor," is a free weekly e-zine from HCPro, publisher of "Briefings on APCs," the monthly newsletter devoted entirely to managing under APCs, and the newsletter, "APC Answer Letter," with answers to readers' questions about coding for APCs.

The "Monitor" is a complimentary companion publication, with a specific mission: to provide answers to your tough questions about the APC regulations.

If you have a question about APC coding that you would like addressed in the "Monitor," post it on our Web site at Each week, our team of experts answers questions that will appeal to the majority of readers. The elected questions and their corresponding answers are delivered to your inbox every Friday.

Start using your -CA code now

ASK THE EXPERT A patient came to our emergency department (ED) with a finger injury. The ED physician ordered an x-ray. The radiologist who read the x-ray stated "no fracture" in the report. The ED physician wrote "fracture of the finger" as his final diagnosis. There are conflicting diagnoses between the two physicians. How should we code this?

TIP OF THE WEEK Grace periods for new codes vary

PAY PER VIEW: When in doubt, go back to paper

When attempting to repair a crashed network, indecision can create the biggest problems for patient care.

On Wednesday, November 13, 2002, Beth Israel Deaconess Medical Center, one of five CareGroup health care system hospitals in the Boston area, experienced a network slowdown.

Over the next three days, network connectivity was restored, but service quality was irregular. Late that Saturday night, the network was restabilized, and by Sunday access to all applications was restored. It was the first time the network had crashed.

From the first slowdown, Beth Israel switched to emergency mode and a back-up paper record system. The hospital didn't return to the online records until Sunday night.

Click here to read more. The cost is $10. Health Care Information Secutiry subscribers have free access via their online subscriptions.

Should we continue to charge terminated C- codes pass throughs separately from the procedures after January 1, 2003 and convert the C-codes to acceptable HCPCS?

Our FIs doesn't know if a claim will be returned to the provider if it contains a non-payable HCPCS. They advised us to submit some dummy claims in January to test. Should we put the supply back into the procedure cost and not bill separately? Is there any documentation for a cross-walk to new accepted codes for those being terminated?

The items which were previously assigned a "pass though" HCPCS code should still be billed on the patient's claim. CMS is no longer providing for "separate" reimbursement for these items as they are now bundled into the APC reimbursement. CMS has told providers that they should still bill for items which are related to a procedure even if their is no separate reimbursement. For those items who were assigned a pass through status in 2002 but are no longer considered pass through there will be no "acceptable HCPCS code". These items should be billed with the appropriate revenue code and no HCPCS code.

FI's have been processing "nonpayable" HCPCS codes since the inception of APCs. Keep in mind that there is no reimbursement for any HCPCS code which has a status of "N" but providers have been required to still bill these items.

Although routine supplies are not billed separately from the procedure, the supply items that do not have a pass through status now would not be considered routine. These items should be billed with the appropriate revenue code such as 27X (the final rule for 2003 instructs providers to refer to PM A-01-050) and no HCPCS code. There is no cross-walk available because the codes have been eliminated, not changed.

Questions from readers are answered by a team of experts working in the APC area within the health care industry. Their answers are provided as advice. Readers should consult the federal regulations governing OPPS, related CMS sources, and with their local fiscal intermediary before making any decisions regarding the application of OPPS to their particular situations.



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Written exclusively for physician practices, it reflects all of the final rule changes. To learn more, including how you can save 10% when you order your copy today, click here or, call 800/650-6787 and mention Source Code EB7878F.


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The new book and CD-ROM set, Guide to Inpatient Clinical Documentation Improvement: Strategies to Ensure Compliance and Correct Reimbursement, outlines a step-by-step solution to ensure the most accurate documentation possible. To learn more, including how you can save 10% on your order, click here or call 800/650-6787 and mention Source Code EB8942A.

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