Health Information Management

Check with your FI

APCs Insider, May 28, 2003

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Briefings on APCs FREE Sample APC Answer Letter FREE Sample

May 16, 2003
Vol. 4, No. 19


Brain Waves

When hooked up to an EEG machine, what food exhibited movement identical to the brain waves of a healthy adult?

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 3-month free trial to one of our APC newsletters!

Pain is induced by silver foil touching a tooth filling because
when two dissimilar metals (aluminum and amalgam) are separated by a conducting liquid (saliva), a current flows between them.

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





The FIs have it
When there is no national policy regarding the proper use of HCPCS/CPT codes, your FI may have the answer. Check with you FI first for its policy on services and procedures and for Local Medical Review Policy specific rules for coding/billing. Your FI should have the correct answer for you.

"It is possible to get paid for something in one state, and not in another," says Diane R Jepsky, RN, MHA, LNC, executive vice president of Coding and Compliance at CodeCorrect, Inc., Yakima, WA.

Facilities adhere to higher level Medicare regulations, National Coverage Decisions, and CCI rules to provide coding guidance, but there is still a lot of gray area not addressed. Medicare leaves the gray area up to your FI to decide.

Check out the following links for varying FI policies and be sure to check with your own FI.


For example, APC Weekly Monitor has strived to provide a correct answer to a question concerning a chemotherapy visit where Leucovorin is administered, immediately followed by a push injection of an antineoplastic drug. It turns out that the correct answer to the question depends upon what FI handles the claim.

Our research indicates there is no consistent policy across Medicare FIs for handling coding of Q0081 with chemotherapy codes.

"If there is no consistent policy that addresses the problem, you should submit a letter to your FI presenting other FI's policies as possibilities," says Jugna Shah, MPH, president of Nimitt Consulting, St. Paul, MN. Shah says CMS needs to address the situation on a national level to clear up the ambiguities caused by the lack of definitive guidelines.

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 TOPIC: Non-covered v. non-billable services

Question: Concerning codes 97010 for Hot/Cold Packs used in Physical Therapy, is this a non-covered charge that we can have the patient fill out an ABN form for and collect from the beneficiary, or is this a non-billable charge that we can't bill Medicare or the beneficiary for? It seems there has been some confusion and a very fine line between what is considered non-billable and what is considered non-covered.

Answer: The line between non-billable and non-covered services can certainly be fuzzy at times. In this case though, there is another rule that comes into play. The reason that hot/cold packs are not separately billable is that they are considered a component of another payable procedure.

Medicare has determined that in some instances a particular procedure is always incidental or bundled to another service and is not separately paid when the main procedure/service is billed and paid. For example, under OPPS you are probably familiar with N status HCPCS codes like bladder catheterization.

Rehabilitation services are not paid under OPPS, but rather the Physician Fee Schedule. In that system, incidental services are labeled "bundled" or B and are packaged or paid with the main procedure/service.

Typically, FIs and carriers do not want bundled services billed on the claim. However, you should check with your FI to determine how to bill this appropriately. It would not be appropriate to request that the patient complete an ABN.

ASK THE EXPERT: We're a hospital-based ambulatory infusion center and we often get patients who walk in unscheduled.

For example, a pediatric patient comes in for hydration of gastroenteritis. During the time that we're hydrating the child, the doctor calls and orders lab work and a stool sample. Can those fall under an E/M code?

Click here for the expert's answer!

PAY PER VIEW Don't let infusions and injections needle you out of money The payment rate for injections and infusions may not be large, but they occur in the outpatient setting so often that facilities can lose significant amounts of revenue if they don't code them correctly. Reimbursement for each procedure can range from around $14 to $150, and if overlooked, can create a big gap between cost and revenues. Read more here. The cost is $10. Briefings on APCs subscribers have free access via their online subscriptions.

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.


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