Health Information Management

Tip: Look at historical charges when prices for combination codes

APCs Insider, May 20, 2011

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Facilities should consider how they will charge for new combination codes-not just those for abdominal and pelvic CT, but also new cardiac catheterization codes and other radiology codes that the AMA has combined into single codes.

The AMA combined the codes because it found that certain procedures are performed together a majority of the time. Because of this, the AMA has reasoned that facilities should realize some efficiencies and therefore incur lower costs. You only have to register and prep a patient once, after all.

The first thing to do is look at your facility's historical charges for the legacy codes and determine how that data translates into a single charge to represent the combined CPT code.

If the historical charges for legacy codes are accurate based on your facility's pricing policy (e.g., a reflection of cost, markup methodology, or other pricing mechanism), then price the replacement code commensurately. Remember that just because the AMA combined two services into a single code doesn’t change the fact that the facility provided two services.

The tip is adapted from “Evaluate charge setting for combination codes” in the June issue of Briefings on APCs.



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