Health Information Management

Two new PMs bring changes

APCs Insider, April 2, 2003

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April 4, 2003
Vol. 4, No. 13


on the fly

Where in the world is the most successful
"Flying Doctor Service?"
(Doctors using planes to provide care)

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!"

In all of history, the most destructive disease is MALARIA.

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





Two new PMs published this week

New PM A-03-020 contains more new corrections to the 2003 OPPS rule, as well as corrections previously announced in PM A-02-129 on January 3, and the Federal Register Correction Notice on February 10, 2003.

(Tired of these changes being made without your input? Join the Provider Roundtable. See below)

Carole Gammarino, RHIT, CPUR, of King of Prussia, PA encourages you to closely read this PM, as it contains crucial information regarding several changes in OPPS.

"Everyone should review this very carefully," says Gammarino. "There may be a significant impact on your services. It's definitely one for the tool box."

Some of the new corrections are:

  • For an inpatient-only procedure performed on an emergency basis, or when an outpatient dies before transfer, the OCE assigns status indicator N and packaging flag 1 for the same date of service as a procedure with modifier -CA. This is effective for claims on or after January 1, 2003.

  • The new HCPCS Code for Optison is C9202 instead of A9700.

  • The payment for HCPCS code A9518, Supply of Radiopharmaceutical Therapeutic Imaging Agent, I-131 Sodium Iodide Solution, Per uCi, has changed.

    Also, the title for APC 1348 was incorrect in Addendum A of the November 1, 2002 final rule. The correct title is, "I-131 solution, per uCi."

    After the April 2003 OPPS release, adjust claims with HCPCS code A9518 that were paid incorrectly and process suspended claims in accordance with the Joint Signature Memorandum dated February 26, 2003.

Unless otherwise noted, all changes in the PM are effective on claims starting April 1, 2003.

Also check out PM A-03-026 for changes that were incorporated into the April version of the revised OCE.

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: When are IVs therapeutic?


A physician discovers an infection in a patient's eye while preparing the eye for cataract surgery. After anesthetizing the right eye, he discontinues the cataract surgery but performs a blepharotomy of the infected eyelids (upper and lower).

The CPT codes we would use in this situation are CPT code 66984 -RT with modifier -74 to show the procedure was discontinued after the administration of anesthesia. We would also report CPT code 67700 with -E4 and 67700 with -E3 and -59. However, our hospital management system (HMS) states you cannot use modifiers -74 and -59 together. Is this true?

Coding and Compliance Feature Article of the Month:

Observation miscoding can cost you


Audit regularly for accurate billing and coding

Conducting an APC audit ensures that your organization identifies, monitors, and rectifies inappropriate billing practices.

Audits benefit your bottom line while simultaneously highlighting potential compliance issues, says Jugna Shah, MPH, president of Nimitt Consulting in St. Paul, MN.

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


A follow up from last week's answer: A patient presents with chest pain and an IV is established as precautionary for untoward events. Though we have not given medication or a bolus, is the IV considered therapeutic from the onset? If not, at what point does the IV then become therapeutic?


Many providers use treatment protocols when initiating a specific plan of care. If the protocol is approved by the medical staff and has been adopted by the facility, it can be used for the basis of billing.

If the treatment protocol is initiated based upon the presence of a sign or symptom and the treatment is designed to treat that symptom, it can billed. If the treatment is precautionary and is designed to prepare the patient to be treated,it cannot be billed due to lack of medical necessity.

The IV becomes therapeutic at the point medication or fluids are administered for a discrete service unit, such as a specific diagnostic indication, such as dehydration, pain control, resuscitation, infection.

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

Got something to say to CMS?

HCPro Inc., Nimitt Consulting Inc., and 3M Health Information Systems are giving you the opportunity to participate in a Provider Roundtable to discuss OPPS and APCs issues with your peers, and then submit your message to CMS.

Be one of 15 individuals who help illicit change by presenting your concerns to the Roundtable for discussion. The group's facilitator, Jugna Shah, MPH of Nimitt Consulting Inc., will document the discussions and prepare them for review by CMS.

The first meeting is tentatively planned for four weeks after the release of the 2004 OPPS proposed rule, which is projected for June or July, and the proposed rule will be the first topic on our agenda.

To be a part of this exciting process, request an application by e-mailing 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.


Briefings on APCs columnist Lolita Jones
pens modifier book

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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.

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.

APCs Weekly Monitor (c) 2003 HCPro, Inc. You have permission to forward APCs Weekly Monitor, in its entirety only, to your colleagues, provided this copyright notice remains part of your transmission. Better yet, send them to where they can subscribe to the newsletter directly. All other rights reserved. None of this material may be reprinted without the expressed written permission of HCPro, Inc.

DISCLAIMER Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions. Users of this service should consult attorneys who are familiar with federal and state health laws.

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