Health Information Management

Q/A: Setting up chargemaster for new codes

APCs Insider, December 31, 2010

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Q: I’ve been working through the new 2011 CPT® codes. I’m finding that not every code has a one-to-one replacement in some areas and combination codes now exist in areas that didn’t have them previously. Multiple items on my chargemaster now have no replacement code. What should I do to be certain that all charges/costs are accounted for under the new codes? 

A: AMA has issued some new all inclusive and combination codes for several tests/procedures/services for CY 2011. When making changes to the chargemaster, be sure to capture all costs/charges from individual deleted codes and include them in the line items for new codes. During 2010, for example, coders reported a left heart catheterization with individual codes to represent the catheterization, the injection procedure, and the imaging supervision/interpretation.

For CY 2011, the AMA combined these into a single code to report the same services. When you set up the new line item for the comprehensive procedure, be certain that the charge on the single line item reflects the same cost/charge information as the individual line items do today. CMS uses the individual hospital’s charge information to determine the cost of a procedure/service. Just because codes change doesn’t mean the cost to a facility has changed. You must be absolutely certain that the charges reported reflect the full cost of the procedure. Otherwise, when CMS uses claims data from 2011 to set payment rates for 2013, the payment rates could be negatively affected.

Other areas affected by this type of coding change that require specific, detailed review are interventional radiology procedures, the new abdomen and pelvis CT combination code, and drugs reported with HCPCS codes. Be sure that you review each of these situations carefully. Changing the HCPCS definition for a drug from “per 10mg” to “per 1 mg” changes the pricing you want to report, the units you need to report, and potentially the reimbursement you’ll receive now and in the future.

Editor’s note: Andrea Clark, RHIA, CCS, CPCH, president of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.

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