Health Information Management

Tip: Accounting for charges with new CPT codes

APCs Insider, March 11, 2011

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The AMA has issued some new “all-inclusive” and combination CPT® codes for several tests, procedures, and services for CY 2011. When making changes to the chargemaster, be sure to capture all the costs/charges from the individual deleted codes and include them in the line item for the new code.

For example, during 2010,coders reported a left heart catheterization using individual codes to represent the catheterization, the injection procedure, and the imaging supervision/interpretation. For CY 2011,a single code denotes the same services. When creating a new line item for the comprehensive procedure, be sure that the charge reflects the same cost/charge information as the individual line items previously did.

CMS uses an individual hospital’s charge information to determine the cost of a procedure/service. Just because the codes change doesn’t mean the cost to the facility changes. Be sure that charges reported reflect the full cost of the procedure; otherwise, payment rates could be negatively affected when CMS uses the claims data from 2011 to set payment rates for 2013.

Other areas that are affected by this type of coding change and require specific detailed review are interventional radiology procedures, the new CT of abdomen and pelvis combination code, and drugs reported with HCPCS codes. Be sure to review each of these situations carefully.

The tip was adapted from “This Month’s Coding Q&A” in the March issue of Briefings on APCs.



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