Health Information Management

HCPCS code should not cause edit

APCs Insider, March 28, 2003

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March 28, 2003
Vol. 4, No. 12

Deadliest disease

In all of history, what has been the most destructive disease?

The answer will appear in next week's APC Weekly Monitor, or be one of the first five to e-mail the correct answer and win HCPro's own "The Official Coding Coach Play Book!"

The risk of heart attack is higher on MONDAY.

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We've got terrific resources for your APC coding team. Check out our two APC newsletters.

"Briefings on APCs" is a monthly newsletter devoted entirely to managing under APCs, including tips, charts, and advice from the experts.

"APC Answer Letter" is a question and answer publication - readers supply the questions, our experts supply the answers. Click on the links to find out more.


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Keith Siddel,
MBA, PhD (c),
president, CEO
HRM, Hospital Resource Management

Cheryl D'Amato,
director health information management
HSS, Inc.

Julie Downey,
ambulatory coding coordinator, HIM
University Colorado Hospital

Carole Gammarino,

Julia R. Palmer
Health Information Management Division of HRM

Valerie Rinkle, MPA,
revenue cycle director
Asante Health System





April 1 deadlines almost here

Any one remember what soap opera debuted on April 1, 1963? If you know it was General Hospital, then you read the February 7 APCs Weekly Monitor and know that starting Tuesday, you can start using new codes and modifiers and submit your charges for the Hepatitis B and flu vaccines.

Here's an April Fool's refresher:

  • CMS will accept Hepatitis B vaccine claims using reinstated CPT codes 90740, 90743, 90744, 90746, and 90747
  • Hospitals may report Low Osmolar Contrast Media (LOCM) Procedures using HCPCS codes A4644, A4645, and A4646 for services on or after April 1, 2003
  • Change the payment indicator to "I" for codes A4232 and A4632
  • Use modifier -GF (non-physician services in a critical access hospital)
  • Use Modifier -UF (morning)
  • Use Modifier -UG (afternoon)
  • Use Modifier -UH (evening)

CMS changes the final rule, sometimes to correct its own mistakes, but sometimes because it heeds the comments presented by healthcare coding professionals like you.

Have you ever wanted to submit comments to CMS but haven't had the time to pull it all together? Do you have concerns about OPPS and APCs but aren't sure how to raise those concerns and have your voice heard at CMS?

Well, this year you may have a chance.

You're Invited to Join Our Provider Roundtable

Join HCPro Inc., Nimitt Consulting Inc., and 3M Health Information Systems at a Provider Roundtable to discuss OPPS and APCs issues of mutual concern and to submit questions and comments to CMS with a united voice.

The roundtable will be made up of 15 individuals who represent the different hospital departments dealing with OPPS and APC changes on a daily basis.

Jugna Shah, MPH of Nimitt Consulting Inc., will serve as the group's facilitator.

The first discussion will be the OPPS 2004 proposed rule. We anticipate meeting approximately four weeks after the release of the proposed rule, which is projected for June or July.

To apply, visit our Web site and complete the on-line application on the resources page or e-mail and request an application. Applications must be submitted no later than May 15, 2003.

Your APCs Weekly Monitor, is a free weekly e-zine from HCPro, publisher of Briefings on APCs, the monthly newsletter devoted entirely to managing under APCs, and the newsletter, APC Answer Letter, with answers to readers' questions about coding for APCs.

The Monitor is a complimentary companion publication, with a specific mission: to provide answers to your tough questions about the APC regulations.

If you have a question about APC coding that you would like addressed in the Monitor, post it on our Web site at Each week, our team of experts answers questions that will appeal to the majority of readers. The elected questions and their corresponding answers are delivered to your inbox every Friday.

HCPCS codes should not cause edit


When billing for IV medication push, each, does that mean per medication or per push?

For example, if a patient has a cardiac arrest in the ED we may give two atropine and five epinephrines. Do we charge IV meds x2 or x7? Is there a data source out there that I can refer to?

Click for the expert's answer.

Coding and Compliance Feature Article of the Month:

Observation miscoding can cost you

Question: Our fiscal intermediary is Trailblazers. We billed the new CPT code 57461 for a February service date. It was rejected because this code was not effective until 03/01/03. I thought all the new CPT codes were effective 01/01/03. Were we misinformed?

Answer: You are correct that the FI should accept this new 2003 HCPCS code however, system files from CMS have an effective date of 3/01/03 for 2003 HCPCS codes despite the fact that the program memorandum state that new 2003 codes may be accepted with dates of service 1/1/03 and later. The FIs do not have the capability to override these date edits in the CMS software. There does not appear to be any recourse but to resubmit claims after 3/1/03 if they include new 2003 HCPCS codes.

You should also contact your FI with this question, as some FIs will not accept the new 2003 CPT codes until 04/01/03 or later, when the update of the OCE takes place.

Keith Siddel, Cheryl D'Amato, Julie Downey, Carole Gammarino, Julia Palmer, and Valerie Rinkle contributed to this week's answer.

Questions from readers are answered by a team of experts working in the APC area within the health care industry. Their answers are provided as advice. Readers should consult the federal regulations governing OPPS, related CMS sources, and with their local fiscal intermediary before making any decisions regarding the application of OPPS to their particular situations.


Briefings on APCs columnist Lolita Jones
pens modifier book

If you subscribe to Briefings on APCs, you've followed Lolita Jones' modifier advice in her monthly column.

Now you can learn even more in her new book, "The Modifiers Clinic: A Guide to Hospital Outpatient Issues."

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She reviews Medicare's official guidelines for reporting modifiers on outpatient claims, and also gives readers a detailed question and answer section addressing the industry's most frequently asked questions. For more information, CLICK HERE and save 10% when you order on line.

You may also call our Customer Service Team at 800-650-6787. Please mention source code EB9202B when you call.

Is your heart in your cardiology coding?

Cardiology is probably an important component on your facility's menu of patient services; it has a huge impact on the bottom line because of the high dollar volume involved.

Click here to find out more about the April 11 live audioconference, "APCs for Outpatient Cardiology Procedures: How to Correctly Code to Get the Money You Deserve." If you'd prefer, call our Customer Service Team at 800/650-6787 and mention source code EZ9066C. We're saving a seat at the audioconference table for you!

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