Health Information Management

Manage denials for inpatient-only procedures

HIM-HIPAA Insider, October 20, 2014

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CMS designates a certain set of procedures as inpatient-only, meaning it will only reimburse facilities for these procedures when they are performed in the inpatient setting. Inpatient-only procedures present numerous problems for hospitals.

For starters, CMS uses outpatient CPT® codes to identify inpatient-only procedures, not ICD-9-CM Volume 3 procedure codes used by inpatient coders. Those CPT codes don't always translate well to ICD-9-CM Volume 3 codes, says Kimberly A.H. Baker, JD, CPC, director of Medicare and compliance for HCPro, a division of BLR, in Danvers, Massachusetts. That disconnect can result in incorrect codes on a claim and also put a facility at risk for an auditor takeback.
"Clinical auditors are often not able to translate from the ICD-9 to the CPT to determine a procedure is inpatient-only," Baker says.
Continue reading "Manage denials for inpatient-only procedures" on the HCPro website. Subscribers to Briefings on Coding Compliance Strategies have free access to this article in the October issue.

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