Health Information Management

Q&A: Can we bill a clinic visit with only status indicator N services?

APCs Insider, August 22, 2014

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Q: Our provider-based clinics occasionally perform only status indicator N (no additional payment, payment included in line items with APCs for incidental service) services. For example, a patient comes in to have oxygen saturation checked and blood drawn. Both services are status indicator N. Should we be adding a clinic visit with HCPCS code G0463 (hospital outpatient clinic visit for assessment and management of a patient)?
A: In deciding whether to report a clinic visit, first consider the reason for the visit. Based on the information available in your question, the patient is scheduled to have his or her oxygen saturation level checked and/or to have blood drawn. 
CMS has a long-standing FAQ that states you can’t bill a visit code just because the patient interacted with staff, as well as guidance that states there has to be a separate and distinct reason(s) for reporting a visit code. It cannot be reported just to obtain payment for the services rendered. 
The CPT® codes for blood drawn from an implanted venous access device and a PICC line are both assigned status indicator Q1 (STV-packaged codes). Both of these codes would be separately paid if they were the only service on the claim, or on a claim with lab services as the only other service. The code for the oxygen saturation is status indicator N and will never be paid separately.
However, CMS states that these “incidental services” claims are processed for cost and resource allocation purposes, so you should submit the claim whether payment is received. This information is then included in future OPPS payment calculations.
CMS created modifier -L1 to allow separate payment of laboratory services under specific scenarios when providers report the services on a 13x bill type. This would apply to the code for venipuncture, as it is paid under the Clinical Lab Fee Schedule. The codes for drawing blood from an implanted device or PICC line should revert to a payable status indicator if the only other service on the claim is for the lab tests. 
Many providers have claim edits that stop incidental services claims from processing, because no payable service is being reported. Based on the above, this is an internal edit that you should review, as the information is valuable for future rate setting and to report the services rendered to the beneficiary. 
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Florida, answered this question.

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular