Health Information Management

Which rate schedule pays for outdated codes?

APCs Insider, February 13, 2003

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February 14, 2003
Vol. 4, No. 6


Valentine's Trivia Question

A bacteriologist discovered one of the greatest developments of modern medicine and introduced it to the world on February 14, 1929. Who was he and what did he discover?

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

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

Window Shopping Monitor-Style
We have 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.


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

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

Julia R. Palmer
Health Information Management Division of HRM

Valerie Rinkle, MPA,
revenue cycle director
Asante Health System





Heart Coding

Valentine's Day seemed an appropriate time to discuss cardiology procedures. According to Lolita M. Jones, RHIA, CCS, using the correct coding for cardiology procedures is extremely critical for a facility's bottom line. One missed code can mean the loss of thousands of dollars. The coder who keeps up to date can be a substantial asset to his or her organization.

Jones said coders should be aware that there is one new CPT 2003 code and two new add-on codes for cardiology procedures.

New codes:

  • G0269 —Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g., angioseal plug, vascular plug).

    According to CMS, placement of an occlusive devices was being inappropriately reported and the new code was created to increase accuracy of payment.

    Along the same vein, CMS developed two add on codes to assure proper reporting and payment of renal and iliac angiography performed at the time of cardiac angiography. They are:

  • G0275 — Renal angiography (unilateral or bilateral) performed at the same time of cardiac catheterization.
  • G0278 — Iliac artery angiography performed at the same time of cardiac catheterization.

    These procedures are performed frequently on Medicare patients and are currently reported using CPT codes 36245 and 36246 for placement of a catheter in the renal and/or iliac artery and CPT codes 75710, 75716, 75722, and 75724 for radiological supervision and interpretation of renal and/or iliac angiography.

  • Do not use CPT codes 36245, 36246 75710, 75716, 75722, and 75724 to report these procedures.

For complete information regarding these codes, see PM A-02-129

For a more in depth discussion on cardiology procedure coding, plan ahead for our audio conference held April 11, "APCs for outpatient cardiology procedures," featuring Lolita M. Jones, RHIA, CCS and Elizabeth Freeze, LPN, CPC-H. These two experts will discuss how to correctly code cardiology procedures to ensure accurate reimbursement.

Healing powers of chocolate not a myth

Don't feel guilty eating those lovely bon bons your sweetheart sent you —Chocolate has its own medicinal properties.

Studies from top universities show the mood elevating brain chemical serotonin is boosted by sugar, and endorphins are released when eating fat. Chocolate derives half of its calories from sugar and the other half from the fat content. Research shows that giving yourself guilt free permission to fulfill your cravings for chocolate, often with only three bites, actually helps you feel better and function more efficiently.

According to Linda Kingsbury, Ph.D., a professional herbalist and natural health educator, phenylethylamine, a chemical in chocolate, is a natural aphrodisiac that is also produced in the brain when one is in love. Magnesium, also found in chocolate, aids in the manufacturing of serotonin and has a relaxing effect on muscles. Theobromine has similar stimulating effects to caffeine and increases alertness. All that in one little Godiva!

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.

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 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.

Which rate schedule pays for outdated codes?


What should we do if a pharmaceutical has had an APC status indicator change from separately payable, such as a pass-through drug, to "N" for incidental or packaged? How do we address this in our chargemaster?


Blood coding in the outpatient arena


If we used a code that was deleted for 2003 and not replaced, would we be paid based on the 2002 rate schedule for this code? Similarly, if we used a code that was deleted and replaced with another code for 2003, which rate schedule would payment be based on?


There are 2003 APC payment rates defined for 2002 CPT/HCPCS that are deleted but which have a grace period for usage up to 3/31/03. Check out the Addemdum B of the 2003 APC final rule in the November 1, Federal Register. CPT/HCPCS codes with "DG" in the code condition column are codes that are deleted for 2003, effective April 1, 2003. These codes have payment rates defined for the period January 1, 2003-March 31, 2003.

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.



Do you understand the new reimbursement opportunities for APC observation services?

A new year always spells APC and OPPS changes, and 2003 brings you new ways to code and bill observation services for APC reimbursement. Are you getting every appropriate dollar for the work you do?

Learn what you need to know during a 90-minute live audioconference, "Observation Services and APC Payments: Key Coding and Billing Changes for 2003 " on Thursday, March 12, beginning at 1 p.m. Eastern.

For more information or to register, CLICK HERE, or, call our customer service department at 800-650-6787. Be sure to mention source code EZ8499B.

Are you getting paid every dollar you earned?

Missed diagnosis codes mean missed revenue opportunities. Getting the diagnosis right is key to getting paid.

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 EZ9466A.

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