Health Information Management

Number of deleted pass-through codes drop

APCs Insider, January 3, 2003

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Keep your eyes open for these changes!

Errors in CPT 2003

Your eyes are not deceiving you - there are mistakes in the CPT 2003 manual. Look for an update to be issued soon, but until then, here are a few of the corrections:

  • Restore the "add-on" symbol to code 22522
  • Remove the "add-on" symbol from code 76006.
  • Restore the "add-on" symbol to code 16036.
  • Restore the "add-on" symbol to code 95975.
  • Include codes 87198 and 87199 as deleted codes in Appendix B.
  • Remove the add-on designations for codes 89055 and 94640 in Appendix B.
There are at least 10 more corrections, so check out the American Medical Association's Web site for the full list of corrections.

When seeing is not believing:

Have you ever thought you recognized someone but when you got closer realized you didn't? We make those mistakes because our brains can only recognize objects by comparing them with previously stored mental images and deciding whether they match.

If the amount we can see is limited for any reason, we make errors in recognition, according to presenters at the Institute of Physics Applied Optics and Opto-Electronics Conference in Loughborough, England.

Professor Alan Lettington and Dr. Alison Fairhurst at Reading University unraveled the mysteries of this part of our mental function by asking volunteers to look at shapes and describe what they saw. The researchers found that lightly disguised objects were recognized easily, but when they reduced the amount of information the brain received from the image, what the volunteers saw wasinfluenced by their personal preferences.

Eye sight or over sight: CMS overpaid $13 billion

About 1,000 of the nearly 5,000 Medicare claims reviewed by the Inspector General's Office of Audit Services did not comply with Medicare laws and regulations, according to the Improper Fiscal Year 2002 Medicare Fee-for-Service Payments (A-17-02-02202) report. IG used the sampling outcomes to determine that CMS overpaid $13.3 billion in inappropriate fee-for-service claims.

At least it didn't get worse. The Medicare fee-for-service error rate remained static in fiscal year 2002, with CMS improperly paying 6.3 % of claims, according to the Jan. 24 Department of Health and Human Services audit report.

Medicare paid out a total of $212.7 billion in claims in FY 2002 and processed more than 1 billion claims.

More than 60 pages of new PMs to learn!

In the everchanging world of APCs, it is difficult to keep up to date. Just in the first few weeks of the year, CMS has issued several pertinent program memos outlining significant changes to the 2003 final rule.

You'll find what you need to know by reading APCAL and Briefings on APCs newsletters, and this e-mail newsletter.


Your "APCs 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 himinfo.com. 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.


TODAY'S TOPICS:

Number of deleted pass-through codes drop

Coding and Compliance Feature Article of the Month

Managing CPT 2003

ASK THE EXPERT

CPT allows a three-month grace period for annual CPT changes for professional coding. I have heard that for the facility/technical side, these 2003 changes must be implemented on January 1 with no grace period. Do any of you have information on this?

PAY PER VIEW

Read between the lines: decipher between actions and words

Glenn Krauss, RHIA, CCS, senior consultant with Healthcare Management Advisors in Alpharetta, GA, suggests coders develop a clinical skill set to help interpret operative reports, compare the procedures performed with the physician's statement of what was performed, and accurately assign CPT procedure codes.

He offers this case study that challenges you to compare the procedure listed to the narrative description of the procedure the physician actually performed.

The cost is $10. Briefings on APCs subscribers have free access via their online subscriptions.


Question:
It has been indicated that there are 95 C codes that need to be deleted without a grace period. I count only 89 in Addendum B of the November 1, 2002 Federal Register. Why is that?

Answer:The best place for information is PM A-02-129. It provides a table with all 95 codes. Perhaps it is a mistake that there are only 89 listed in November 1, 2002 Federal Register.

Originally, the number of expired pass-through devices totaled 95, but the number is now down to 90 since C1716, C1718, C1719, C1720 and C2616 have been assigned their own APC. They are no longer pass-throughs, but are also not packaged, so these five C-codes are still allowed for reporting purposes.

Providers should not think that because all 95 of these codes lose pass-through payment status that they also all lose separate payment. Only 90 of the C-codes that we were used to generating pass-through payment become packaged. The other five from the list are paid for separately so providers should continue billing those.


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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MISSED DIAGNOSIS CODES MEAN MISSED REVENUE OPPORTUNITIES

Getting the diagnosis right is key to getting paid. There is help available to get a handle on more than 160 new diagnosis codes and their proper use.

Attend a live audioconference, "The New ICD-9 Diagnosis Codes: Understanding the Changes and their Use" on February 26. Get your questions answered in real time following the presentation. For more information or to register, CLICK HERE, or call our customer service department at 800-650-6787. Be sure to mention source code EZ8282C.




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