Health Information Management

Codes subject to OCE Edit 15 named

APCs Insider, May 28, 2003

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



Briefings on APCs FREE Sample APC Answer Letter FREE Sample HIMINFO.com

Friday,
May 30, 2003
Vol. 4, No. 21



SUBSCRIBE


What is believed to be mankind's oldest surgical procedure?

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

LAST WEEK'S ANSWER:
The Monitor editor's MOM
turned 80 last Friday.



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.

SPONSORS



INFO-X

Medical Necessity Solutions

With Info-X you can integrate your local LMRPs and NCDs into your HIS. Leverage existing system capabilities to provide ABN alert, print the ABN and apply the appropriate occurrence codes.

Increased reimbursement, minimum cost, risk, infrastructure, training/education & least time to implement.

For more information, click here or call 800-299-1091 ext. 34.


IRP, Inc.

IRP's CODING SOFTWARE

Specifically designed for Medicare APC compliance, IRP's coding software fits ALL platforms and is easily integrated with existing applications. Visit our comprehensive APC Reference Library.

Click or call 800-634-0496 x244.

THE MONITOR'S ADVISORY BOARD

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

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

Julie Downey,
CPC, CPC-H,
ambulatory coding coordinator, HIM
University Colorado Hospital

Carole Gammarino,
RHIT, CPUR,
Independent
Consultant

Julia R. Palmer
MBA, RHIA, CCS,
president
Health Information Management Division of HRM

Valerie Rinkle, MPA,
revenue cycle director
Asante Health System


On Himinfo.com

TIP OF THE WEEK

ASK THE EXPERT

HIM VENDOR BUSINESS DIRECTORY

Codes subject to OCE Edit 15 named

CMS put Edit 15 (service unit out of range for procedure) back in play on April 1, 2003, but did not identify which OPPS codes would be affected by the edit. The following six codes are currently subject to the edit:

  • C2616 - Brachytx seeds, Yttrium-90
  • G0256 - Prostate brachy with palladium
  • G0261 - Prostate brachy with iodine
  • G0273 - Pre-treatment planning for non-Hodgkins disease
  • 76090 - Mammogram, one breast
  • 76091 - Mammogram, both breasts
CME currently has 60 different edits. Only two, edit 7 for procedure and age conflict and edit 51 for multiple observations overlapping time, are not activated. For more information on the OCE Edit 15, see PM A-03-019.


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 himinfo.com. Each week, our team of experts answers a question that will appeal to the majority of readers. The elected question and the corresponding answer are delivered to your inbox every Friday.


TODAY'S TOPIC: How to code education and evaluation of self-administering therapy

Question: Do we use code 94664 only when a patient will be self-administering his or her therapy? Is a specific physician's order required for the patient to be taught? What is included in the initial therapy? Does it include the routine education or is it specific to those patients who will be using the therapy at home? Should 94640 ever be used for the initial treatment?

Answer: 94664 includes the demonstration and/or evaluation of patient use of an aerosol generator, nebulizer, metered dose inhaler, or intermittent positive pressure breathing device. This service may be provided in various hospital outpatient departments or in the ER.

94664 can only be reported one time per day. It includes the education by the respiratory therapist prior to the patient self-administering the treatment. This service should either be ordered by the physician, or a committee-approved patient protocol.

94640 is used to report the actual treatment typically administered by an RT or RN. This code can be reported more than once on the same day if modifier -76 is appended.

However, according the the National Correct Coding Initiative, 94664 must be entered alone when demonstrating the use of the respiratory device to the patient.

If a treatment is given on the same, by the same personnel in the same department as the demonstration/evaluation of the patient use of the device, 94664 becomes a component of the more comprehensive procedure 94640.

When the demonstration/evaluation is performed in a different department, by different personnel, it may qualify for modifier -59.

When using these treatments in the ER, 94640 carries a status indicator of S so it is not subject to multiple procedure discounting. If this is the only procedure performed during the visit, modifier -25 should be appended to the E/M level code to ensure reimbursement for this procedure.


ASK THE EXPERT: A patient comes into the ED by ambulance. The IV was started in the field and they were also infusing saline. The nurses in the ED start a second bag of saline. Can we charge for an infusion?

Click here for the expert's answer!

PAY PER VIEW: The bane of bunion coding: Too many codes to choose from

One simple diagnosis-bunions-can involve one of nearly a dozen CPT procedure codes. Coders need to use every piece of information in the operative report to correctly code bunion repairs.

Read more here. The cost is $10. Briefings on APCs subscribers have free access via their online subscriptions.

Coding and Compliance Feature Article of the Month: Interventional procedures cause coding confusion


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.


EDITOR'S CHOICE

Is your Chargemaster up-to-date?
If not, you could be losing thousands of dollars and jeopardizing your compliance standing with the government. Don't take chances!

Plan to spend 90 minutes on June 17 for an important audioconference, "Essential Chargemaster Maintenance: Best Practices to Ensure Positive Financial Outcomes and Compliance." It's a small investment compared to what you could be losing.

To learn more or to register, CLICK HERE or call our customer service department at 800/650-6787. Be sure to mention source code EZ0175B.

It's time to "Lunch & Learn" about health care report cards and coding for severity

Have you ever wondered how your hospital and physicians would fare if graded against another facility in your area? That information is available to the public on consumer Web sites. It is essential that your hospital's data accurately reflect clinical documentation.

Gather your colleagues for a brown bag lunch and listen to the easy-to-understand "Coding Lunch & Learn: Health Care Report Cards and Coding for Severity" from HP3 and HCPro. Train every member of your department and award them each a certificate for valuable continuing education credits.

For more information, CLICK HEREor call our customer service department at 800/650-6787. Be sure to mention source code EZ0819A.

SIGN UP FOR A FREE CODER TRAINING E-MAIL NEWSLETTER

Sign up for your complimentary subscription to hcProCoder Connection today and you're on your way to better compliance with the OIG, CMS, and other regulatory standards. Every two weeks you'll get the latest issue of delivered right to your e-mail's inbox. Each edition will feature a training quiz to keep you sharp on correct coding. The first issue launches June 4. Subscribe today, click here.



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