Health Information Management

Wound repair, observation and E/M level coding

APCs Insider, April 11, 2003

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April 11, 2003
Vol. 4, No. 14


Killing time

Going ten straight days without what will kill you?

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 a free cup of coffee!

Australian Royal Flying Doctor Service:

53 doctors, 103 nurses, & 95 pilots treated 181,621 patients in one year.

Window Shopping Monitor-Style
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





Don't wait for new effective date for drug-eluting stents to begin preparation for new G-codes

Many expected the Food and Drug Administration (FDA) would approve drug-eluting stents this month, but don't sit around and wait. CMS said it would announce a new effective date for the codes if the FDA did not grant approval by April 1, 2003. Don't wait for that, either. Instead, our experts suggest you prepare your facility now.

"Don't delay. Get this information into your billing process now," says Glenn Krauss, RHIA, CCS, vice president coding compliance, DCBA in Atlanta.

CMS created two new HCPCS codes to track the use and costs associated with the drug-eluting stents: G0290 and G0291, under APC 0656. Drug-eluting stents are being used in inpatient Medicare qualified clinical trials but until FDA approves the stents, they can not be used in an outpatient setting.

The proposed CMS relative weight is 96.75; the approximate payment is $5,045.69; and the approximate co-payment is $1,009.14. The status indicator is T. The APC includes payment for the procedure and the stent, says Diane R. Jepsky, RN, MHA, LNC, executive vice president of coding and compliance at CodeCorrect Inc., Yakima, WA.

Take these steps:

  • Input new HCPCS codes G0290 and G0291 into chargemaster
  • Educate coding staff to properly use ICD-9 and HCPCS procedure codes
  • Monitor billing once the new codes are in use to ensure HCPCS and ICD-9 procedure codes appear on UB-92 claims

Eventually, the drug-eluting stents will be coded using CPT codes. According to February 2003 issue of CPT Assistant, the data taken from claims through the G-codes will be incorporated into the current CPT codes for coronary stent placement.

"CMS believes that the current CPT codes describe the procedure adequately and that separate permanent codes for the use of drug-eluting stents are not necessary, based on the expectation that drug-eluting stents eventually will become the standard of care," according to the CPT Assistant.

(Want CMS to know what YOU think? Join the Provider Roundtable. See below)

Reminder: Don't forget to review new PM A-03-020 and PM A-03-026 for changes effective April 1.

Honolulu bound?

HCPro, Inc. is looking for a few good hospital coding managers! We need a small group to share thoughts on coding concerns, obstacles, goals, successes, training, and more. To accomplish this, we have scheduled a FREE lunch during the upcoming AAPC conference in Honolulu. If you're attending and would like to participate in this lunch on Monday, April 14 (lunch is on your own that day), please e-mail Lauren McLeod.

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.

TODAY'S TOPICS: Wound repair, observation and E/M level coding

TIP OF THE WEEK: Navigate the ins and outs
of wound repair with these reference tools

Coding and Compliance Feature Article of the Month:
Observation miscoding can cost you


If a patient in a clinic or ED setting leaves by his or her own choice before being seen by a physician, is the facility level a billable service? After all, nursing personnel took vitals, asked the reason the patient wanted to be seen, and may have also performed pulse oximetry. These services qualify as a low level E/M under our hospital-specific facility criteria.


Yes, you can charge a low level E/M to patients who are triaged and then leave, as long as it is part of your E/M criteria and the level is consistent with the services provided. (See April 7, 2000 OPPS rule page 18452.) However, some facilities choose not to charge.

CMS requires only that you develop your own system of coding and billing for E/M services and that you consistently follow it. Additionally, services must be documented and medically necessary.

Triage should be defined as the gathering of sufficient information to determine the severity of the patient's condition. It is important to note that patients who sign into the ED on a sign-in sheet are not necessarily triaged. Also, vital signs alone do not indicate triage.

Facilities that charge for these services must do so for every triaged patient who chooses to leave, in order to comply with the Medicare requirement that all patients be billed consistently for the same service. Providers should be aware that this can be a patient relations concern as patients may complain about the ED charges because in their mind, no services were rendered.

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

Looking for proactive HIM professionals
for our Provider Roundtable

We know that as a representative from one of the many sides of health information management, you have valuable input to present to CMS, but you probably don't have time to prepare and submit comments.

That's why HCPro Inc., Nimitt Consulting and 3M Health Management Systems are encouraging you to participate in a Provider Roundtable to discuss OPPS and APCs issues.

  • 15 individuals will be selected to serve one- to two-year terms.
  • The first meeting will be held in the St. Paul/Minneapolis area soon after CMS publishes the proposed 2004 rule.
  • Jugna Shah of Nimitt Consulting Inc. will serve as group facilitator and technical writer.
To be a part of this innovative process, e-mail
Jugna Shah at Nimitt Consulting Inc. Applications must be submitted no later than May 15, 2003.

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.


New Coding Lunch and Learn 2003 CDs are here!

Gather your colleagues for a brown bag lunch and listen to the easy-to-understand CODING LUNCH AND LEARN 2003: THE 5W's OF INPATIENT DOCUMENTATION. Learn the "who," "what," "when," "why," and "where" keys to improve documentation. You'll even earn valuable continuing education credits while you Lunch and Learn.

For more information, CLICK HERE or call our Customer Service Team at 800-650-6787. Please mention source code EZ0727A when you call.

Why are breast procedure and mammography coding and documentation so important?

Are you aware of recent coding and modifier changes for breast procedure coding? It's critical that it is done accurately, in a timely manner, and in compliance with government standards to avoid false claims. It's important to the fiscal well-being of your facility and to ensure that patients receive appropriate results of their procedures.

Learn what you need to know during a 90-minute live audioconference, "Strategies for Accurate Breast Procedure and Mammography Coding" on Tuesday, April 29, beginning at 1 p.m. Eastern. You need a solid understanding to be in compliance.

For more information or to register, CLICK HERE or call our customer service department at 800-650-6787. Be sure to mention source code EZ9087A.

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