Health Information Management

July 2003 update of OPPS and OCE

APCs Insider, June 27, 2003

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Vol. 4, No. 24



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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

CMS issued July 2003 update of OPPS and OCE

PM A-03-051, an OPPS update, was released on June 13, 2003. Here are some of the highlights:

Code changes:

  • Drug-eluting stent codes in effect July 1, 2003
  • C1818 added to pass-through device list
  • Three MRA procedure codes for the pelvis added
  • HCPCS code for Oxaliplatin added
  • Octreotide acetate depot and Pegfilgrastim have new Q-codes
Criteria changes:
  • Separately payable observation APC criteria corrected
  • Specified diagnostic services criteria clarified
  • Multiple line items of I-131 now allowed

To read the complete PM A-03-051, check out CMS Central on HCProCoder.com. Don't forget to review the July OCE changes in PM A-03-048 while you are there.


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.


Reviewing the chemotherapy coding question: An in-depth Special Report of how FI policies differ in coding Q0081 with chemotherapy provided by APC experts Jugna Shah, MPH, and Valerie Rinkle, MPA.


TODAY'S TOPIC: Coding pre-op work

Question: A patient comes to the hospital for pre-operative work up for outpatient surgery.The patient has the actual surgery the following day. Would it be appropriate to charge the V72.84 code in addition to the surgical code?

Answer: If there are pre-operative diagnostic tests performed on a day other than the surgery, then V72.84 is an appropriate code to add to the case.

To determine the validity of using the V-code, ask yourself these questions:

  • Is there another underlying medical condition for performing the pre-op testing that is provided by the ordering physician (i.e. heart condition, diabetes, etc.)? If yes, then code the condition that warrants the testing.

  • Is the visit for an unspecified or specified pre-operative exam? If unspecified, use V72.84. If specified, use V72.83. If a cardiovascular exam is specified, use V72.81. The actual procedures are coded as same day surgery accounts.

  • Do these diagnoses pass local medical review policies or national coverage determinations guidelines? If not, issue an advance beneficiary notice to the patient.

TIP OF THE WEEK: Correctly code and bill for heel pad injection

ASK THE EXPERT: We are a cardiology practice that has several stand-alone testing facilities. Does the HIPAA privacy rule require us to hand patients our privacy notice and have them sign an acknowledgement of receipt when they have testing that requires no office visit? Click here for the answer!

PAY PER VIEW: Stop bleeding from your ED

Every time your ED doors swing open for a patient, potential facility revenue could be flying right out. According to Frank Freeze, LPN, CCS, CPC-H, hospital are losing hundreds of thousands of dollars in reimbursement from their EDs alone. Read how to track data and discover where your facility financial leaks are.

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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EDITOR'S CHOICE

There's one thing you can count on in the world of OPPS and APCS: The rules keep changing.

That's why we're bringing you an important audioconference, "OPPS 2003 and 2004 Changes and Challenges: Tools for Success," on July 8 beginning at 1 p.m. Eastern.

You'll get tools to strengthen your OPPS and APC coding and reimbursement. As the months roll by in 2003, new program memos present changes to the final rule. The 2004 proposed rule will present more challenges in the coming months.

To register or to learn more, CLICK HERE or call our customer service department at 800/650-6787. Be sure to mention source code EZ1195B.

Looking for a solid reference on appropriate modifier use? Try the new "The Modifier Clinic" book

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Jones addresses crucial operational issues associated with modifier reporting using practical exercises, case studies, and detailed figures. 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.

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Save 10% when you order online! You may also call our Customer Service Team at 800-650-6787. Be sure to mention source code EB1489B when you call.




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