Health Information Management

Second drug-eluting stent in approval process

APCs Insider, July 27, 2003

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July 11, 2003
Vol. 4, No. 27


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The first three United States presidents to die on the Fourth of July are

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"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




Second drug-eluting stent in approval process

Boston Scientific Corp., the second company to file a drug-eluting stent application with the Food and Drug Administration, hopes to begin selling its TAXUS Express stent late this year or early next. The stent delivers the anticlogging drug paclitaxel while propping open clogged artieries.

Johnson & Johnson was the first company to gain approval in April of this year. Since then, business reports say, Johnson & Johnson has not been able to keep up with the demand for its Cypher stents.

In its quarterly report, Boston Scientific announced that its TAXUS Express paclitaxel-eluting coronary stent system has been well received in Europe and other international markets and has received regulatory approval in Australia and Korea.

If you missed last week's Monitor because you were off enjoying the holiday, here's a recap:

First E/M guidelines draft submitted to CMS

Members of an expert panel have proposed new E/M guidelines using a hospital staff intervention-based system that incorporates a point system. CMS will review the guidelines and issue a final version, slated to become effective in 2004.

The three key principles of the guideline proposal:

  • The new E/M code set should accurately capture hospital resources—but not physician services— consumed during an emergency or a clinic visit.
  • Discrete hospital services that are separately billable, such as lab tests, should not be used in determining the coding level.
  • Any coding model(s) developed should be billable to all health care payers, not just Medicare.
Three coding models for three types of care:
  • Emergency department services - divided into a three-level system of intervention: low, mid, high
  • Clinic services - also divided into low, mid, and high
  • Critical care

To review the complete document, check AHIMA's web site.

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: Using modifiers -59 and -76 with 93041 and 93005

Question: Can I append modifier -59 to CPT 93041 when done with CPT 93005 for billing purposes?

Answer: It would be helpful to know why these two codes were used, but based on several assumptions, here is the answer:

93041 is a component of code 93005. If two different types of tracings were done separate and independent from one another, codes 93041 and 93005 with modifier -59 would be appropriate. If serial EKG's were performed to monitor the patient's condition and were reported with the same code, each must be reported on a separate line. Modifier -76 would be appended to each additional code in this case.

PAY PER VIEW: Documentation templates can be silver bullets or smoking guns, Georgette Gustin, CPC, CCS-P, CHC, a director at PricewaterhouseCoopers in Indianapolis, told attendees during the recent American Academy of Professional Coders annual conference in Honolulu. Most health care organizations have many templates or forms in use. These templates can prompt clinicians to provide detailed documentation. But in some cases, they can hurt your compliance efforts.

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

Ask the Expert: What are the codes for right heart catheterization only?

Click here for the answer!

TIP OF THE WEEK Formalize coding guidance

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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Are you collecting every dollar you're entitled to for emergency department visits?

If those visits aren't documented appropriately, you could be losing a lot of money. One Massachusetts hospital hired a consultant who revamped the documentation processes and found an average loss of $100,000 in missed revenue — per month!

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How are you going to get ready for the 2004 proposed OPPS rule?

Implementing the 2004 OPPS rule will be easier if you let us help. Participate in our live audioconference, "2004 OPPS Proposed Rule Understanding and Implementing the Changes Audioconference" Tuesday, August 19.

Our speakers will read and digest the proposed rule and give you the tips and strategies you need to get ready.

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