Health Information Management

Summary of 2004 proposed rule

APCs Insider, August 15, 2003

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August 15, 2003
Vol. 4, No. 32


Old bones

What age are you when the bones in your wrist become fully developed?

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!

The proposed 2004 rule published in the Federal Register, August 12, 2003 has 50 PAGES, not including the addendum.

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

Andrea Clark
Health Revenue Assurance Associates

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

Julie Downey,
ambulatory coding coordinator, HIM
University Colorado Hospital

Carole Gammarino,

Julia R. Palmer
president, Health Information Management Division

Valerie Rinkle, MPA,
revenue cycle director
Asante Health System




Summary of 2004 OPPS proposed changes

You wait in exalted anticipation every year for the OPPS proposed rule to be published, and when it finally comes out, you're on vacation!

If you missed the announcement that the proposed rule was posted Tuesday, August 12, here is a quick summary of the changes.

For a review of the proposed rule by Jugna Shah, MPH, check out

Summary of proposed changes for 2004 OPPS

Sign up for our "2004 OPPS Proposed Rule: Understanding and Implementing the Changes," audioconference on August 19, 1 p.m. Eastern to get ahead of the changes. Speakers Jugna Shah, MPH, and Gloryanne Bryant, RHIT, CCS, will help you begin the transition to 2004 OPPS. To register, Click here or call our customer service team at 800/650-6787.

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 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: Outpatient and non-patient defined

Question: If a patient comes to the lab to drop off a urine specimen for a lab test, is this considered an outpatient encounter or a non-patient specimen?

Answer: First, let's review the definitions of outpatient and non-patient encounters.

An outpatient is registered as an outpatient instead of admitted as an inpatient and receives services (rather than supplies alone) from the facility.

A non-patient service refers to a tissue sample, blood sample, or specimen that is taken by personnel other than those employed at the facility. The sample is sent to the facility for tests, and the tests are considered non-patient hospital services since the patient does not directly receive services from the facility.

In most hospitals, an outpatient specimen must be accompanied by a physician's order or the test will not be performed. The patient registers as an outpatient in the registration department and proceeds to the lab with the urine, making this an outpatient diagnostic service.

The facility must document medical necessity, and if needed, it should issue an ABN or gather information from the physician's office. The appropriate demographic and insurance information needs to be entered into the system for future billing and collection.

However, sometimes a patient will want a lab test for his or her own purposes, such as drug testing, HIV testing, etc. If there is no order from a physician, the test should be registered as a self-pay or cash account. In this case, the patient must be present and show a picture ID before the specimen is given.

Be aware that many providers and some states have restricted the ability of laboratories to perform tests without an ordering physician. If a patient was to receive results without proper interpretation, a facility may worry that the laboratory could be held liable.

PAY PER VIEW: Proposed E/M guidelines bring promise with potential pain

E/M facility levels have been the plague of outpatient facilities and departments for three years, as hospitals are required to come up with their own criteria. But there may be some relief in sight.

In June, an independent panel of experts, led by members of the American Hospital Association (AHA) and American Health Information Management Association (AHIMA), made history by submitting the first draft of proposed guidelines for standardizing E/M services for OPPS.

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

ASK THE EXPERT: We are in the process of converting to an electronic medical record (EMR) system. At present we use a super bill with all of the appropriate evaluation and management (E/M) codes for our office visits listed.

We are concerned because the EMR only lists certain E/M levels of service instead of listing all the E/M levels in the EMR for selection by the practitioner. We feel that this could be construed as leading the practitioner to only code certain levels of E/M service for the office visit.

Can you tell me whether this is in fact an issue to be concerned with? Can you tell me whether CMS addresses this issue? If so, where can I find information regarding leading the practitioners and whether this applies to a paper super bill as well as an EMR?

Read HERE for the expert's answer!

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.


Coding Lunch & Learn for severity coding!

It's time for another quot;Coding Lunch & Learn session.quot; Gather your colleagues for a brown bag lunch and listen to the easy-to-understand program on secondary diagnosis coding program from HP3 and HCPro. There are specific details of ICD-9 code assignment required to capture the appropriate level of severity and quality of care outcomes. Train every member of the staff and award everyone valuable continuing education credits while they quot;Lunch & Learn.quot;

For more information, CLICK HERE or call our customer service department at 800/650-6787. Be sure to mention source code EZ0839A. For more information, CLICK HERE. You may also call our Customer Service Team at 800-650-6787. Please mention source code EB1793E when you call.

The new codes are coming, the new codes are coming!

New ICD-9-CM codes take effect on October 1. Do you know what the new codes numbers are or how to use them? Failing to implement will delay your ability to process claims on a timely basis.

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