Health Information Management


APCs Insider, May 28, 2003

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Briefings on APCs FREE Sample APC Answer Letter FREE Sample

May 2, 2003
Vol. 4, No. 17


Breathing Lessons

How many breaths does the average adult take in one day?

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 "2003 Coding Coach Play Book"!

LAST WEEK'S ANSWER: Intelligent people have more

in their hair, although the favored answer was "gray"!

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





FDA approves drug-eluting stents
But you still can't use the G-codes

The Food and Drug Administration (FDA) approved the first drug-eluting stent for angioplasty procedures last week on April 24, however, the codes cannot be reported until further instruction from CMS.

The long-awaited FDA approval came after prior guidelines set by CMS for billing the procedure became invalid. CMS created the codes in January in anticipation of FDA approval, and had set forth billing instructions in PM A-02-129, for procedures performed before April 1, 2003.

CMS says it will be releasing an upcoming program memorandum outlining the new effective date and proper use of G0290 and G0291.

"These two HCPCS codes should be used to report the placement of the stent, and any other therapeutic intervention that may have been performed prior to the drug-eluting stent placement," says Byron Johnson, RHIA, CPC-H, senior consultant at The Wellington Group Valley View, OH.

That includes intervention performed in any given vessel, such as percutaneous transluminal balloon angioplasty.

These codes compact to APC 0656 and have an unadjusted payment of $5,045.69, according to 2003 final rule, addendum A.

"This payment is not an addition to the already reduced pass-through device list," Johnson says. "The APC 0656 payment includes the procedure as well as the new drug-eluting stent device."

To ensure that future updates of the G codes accurately reflect the cost of the stent, the mark up should be such that actual cost is calculated by CMS when they apply the OPPS cost-to-charge ratio, says Valerie A. Rinkle, MPA, Revenue Cycle Director, Asante Health System, Medford, OR.

"Even though the actual drug-eluting stents do not have pass-through device status, they should be billed separately," she says.

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.

Changes in OPPS and APCs regulations don't always make your job easier. How often have you thought, "If only they had asked me!"

Here's your opportunity to let CMS hear your concerns and those of your peers.

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

Jugna Shah, MPH of Nimitt Consulting Inc., the group's facilitator, will assist members in documenting their comments and questions and submitting them to CMS.

Apply now, there are only two weeks left before the deadline. E-mail Jugna Shah and request an application. Deadline for submitting applications is May 15, 2003.

TODAY'S TOPICS: Infusion confusion

Correction: In last Friday's Monitor, the answer published was unclear due to an editing error. Our panel of experts answered the reader's question correctly, but in the editing process it lost its meaning. We regret the error. Here is the revised question and answer.

Question: Can we code both Q0084 and Q0081 for a patient in an outpatient infusion center with physician orders for a chemotherapy infusion and a leucovorin infusion?

Answer: There is a better code to use in that case. Leucovorin is often given in combination with chemotherapy. Usually, the Leucovorin is infused through IV tubing over 15 to 30 minutes, and then the chemotherapy is given as a bolus push. This would not qualify for a separately identifiable infusion (Q0081) along with Q0084 for chemotherapy infusion only.

Since leucovorin is integral to the chemotherapy, this is better coded as Q0085, Chemotherapy administration by both infusion technique and other technique(s) (e.g., subcutaneous, intramuscular, push), per visit.

Question:There are new definitions in 2003 to respiratory therapy codes 94664 and 94640 as well as new NCCI edits. Can the department bill the 94664 and the 94640, together for the initial treatment and evaluation? You can add modifier -59 to the 94664. Is this correct?

Answer: If both the initial treatment 94640 and the demonstration/evaluation of the patient's use of the device are performed at the same session by a respiratory therapist, then only the treatment 94640 should be charged. If the initial treatment is by a respiratory therapist in the ED and then a subsequent demonstration/evaluation by the respiratory therapist is performed, then the -59 modifier is justified on the 94664.

Coding and Compliance Feature Article of the Month:
Hospitals stand to lose revenue with drug-eluting stents

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.



Join HCPro for the 90-minute live audioconference, "Medicare's 3-Day Payment Window: Are You Prepared if it Expands?" and ensure you have policies in place to make sure these outpatient and inpatient bills are combined when appropriate.

This program will be presented on Thursday, May 15th, 2003. To register, or learn more, Click here or, call 800/650-6787 and mention source code EZ9284C.

Coding Lunch & Learn ED coding CDs available

It's time for another Coding Lunch & Learn session. Gather your colleagues for a brown bag lunch and listen to the easy-to-understand ED Coding-Facility Leveling program from HP3 and HCPro.

It focuses on the challenges of ED coding, looks at actual ED records, and offers practical solutions for accurate assignment of facility levels. Train every member of the staff and award everyone valuable continuing education credits while they "Lunch & Learn."

For more information, CLICK HERE or call our customer service department at 800/650-6787. Be sure to mention source code EZ0810A.

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