Health Information Management

The window of opportunity for missed C-codes

APCs Insider, February 7, 2003

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February 7, 2003
Vol. 4, No. 5


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And now some April Fool's trivia:

Which daytime soap opera debuted on April Fool's Day in 1963?

The answer will appear in next week's APC Weekly Monitor, or e-mail your answer and win a free cup of coffee!



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THE MONITOR'S ADVISORY BOARD

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

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

Julie Downey,
CPC, CPC-H,
ambulatory coding coordinator, HIM
University Colorado Hospital

Carole Gammarino,
RHIT, CPUR,
professional services consultant
Precyse Solutions

Julia R. Palmer
MBA, RHIA, CCS,
president
Health Information Management Division of HRM

Valerie Rinkle, MPA,
revenue cycle director
Asante Health System


On Himinfo.com

TIP OF THE WEEK

ASK THE EXPERT

HIM VENDOR BUSINESS DIRECTORY

Don't be fooled when coding Hepatitis B!

It's not April Fool's yet, but it probably feels like it to coding professionals: CMS has changed the Hepatitis B vaccine coding procedure again, and all Hepatitis B vaccine claims must be held until April 1, 2003.

It started in November, when CMS established new Q-codes to replace CPT codes 90740, 90743, 90744, 90746, and 90747.

The changes were made to version V4.0 of the OPPS OCE, but before the codes could become effective January 1, CMS changed its mind and reactivated the CPT codes and the Q-codes became history.

However, CMS will not accept the CPT codes until April 1, when the OPPS OCE will be updated to reflect the appropriate Service Indicators for the vaccine and the CPT codes will be back in business.

Check out the complete program memo updates here.

Still looking for CPT changes?

For those of you unable to track down the CPT 2003 errata on the AMA Web site mentioned in last week's "Monitor," we apologize. It is tricky to find. Here is a direct link.

Check out this month's issue of Briefings on APCs to keep up to date on all the changes presented in recent program memos, including expired pass-through C-codes, new G-codes, and tips on correctly coding knee and shoulder surgery.


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:
The window of opportunity for missed C-codes

ASK THE EXPERT

If a physician removes or excises a lesion, can he or she wait until the pathology report comes back before billing for it?

TIP OF THE WEEK

New G-code ends one modifier -59 headache


Question:

How far back can a facility go to re-bill or adjust claims to show missed opportunities with C-codes through Medicare?

Answer:

Medicare providers have at least 15 months from the date of the service to submit a claim to Medicare. However, claim payment for assigned claims will be reduced by 10 percent if the claim is not filed within one year of the date of service. Providers may not bill the patient for this reduction.

The list below provides the filing deadline for the date of service ranges indicated.