Health Information Management

Rabies vaccine status 'N'

APCs Insider, November 6, 2003

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November 7, 2003
Vol. 4, No. 44


Celebrity Coding

Julia Roberts suffered from what disease in the movie Steel Magnolias? Name the code.

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 HCPro newsletters!

In Medieval times, a spider was rolled in butter and swallowed as a cure for what disease?
Plague and leprosy

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

Jeannie Gourgeot
Director of HIMS
St. Joseph's Medical Center

Julia R. Palmer
president, Health Information Management Division

Valerie Rinkle
revenue cycle director
Asante Health System




CMS Releases 2004 OPPS final rule

Don't look for new E/M level guidelines "any earlier than January 2005," CMS says in the 2004 OPPS final rule published Friday, October 31. The agency says it will provide at least six to 12 months' notice before implementing new E/M codes and guidelines.

Also staying the same is the description for Q0081, Q0083, and Q0084, which will not be changed to "per day," as proposed, but will remain "per visit." Until national guidelines are in effect, local medical review policies published by individual FIs will stand.

There will be some chemotherapy administration changes in 2004. HCPCS code Q0085 will no longer be payable under OPPS, so providers will have to report Q0083 and Q0084 when chemotherapy by both infusion and other techniques is provided in the same visit. The APC payment rate for Q0081 and Q0084 will be lower in 2004, and while providers will be able to report both Q0083 and Q0084 in lieu of Q0085, the total payment for these codes will be much lower than the current payment rate for Q0085.

Hospitals will not be required to use HCPCS codes when billing packaged drugs, but they will need to continue using revenue code 636 when reporting separately payable drugs. CMS has also stated that it will be reinstating the category device C-codes, but providers will have a choice about using them. The use of the code is not required and will not be enforced. However, hospitals should understand that providing complete and accurate information on the claims about the services that were furnished and the charges for those services is fundamental to our establishment of relative weights on which payment for their service is based.

Although CMS had proposed a 10% or greater reduction in payment rates for blood and blood products, it will keep these rates frozen at the current 2003 levels.

Click HERE to read the final rule. For more detailed information, check out our audioconference, APC Task Force on December 9, and the December issue of Briefings on APCs.

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: Rabies vaccine status 'N'

QUESTION: According to the CPT book, the correct codes to bill for rabies vaccination are 90675 "Rabies vaccine" and 90471 "Immunization administration." Both of these codes have status indicator 'N,' however, so there is no payment. Is this really what Medicare intended? Should we use the 90782 "Injection subcutaneous, intramuscular"--which is reimbursed under APCs--instead of 90471?

ANSWER: Based upon CPT guidelines, rabies vaccination administration is coded 90471, "Immunization administration, one vaccine" and the rabies drug product is coded 90675, "Rabies vaccine, intramuscular use." For APC payment, both listed codes have status indicator 'N' which indicates packaged services. It is inappropriate in this case to report 90782 in lieu of 90471.

You must report both codes 90471 and 90675 with appropriate charges to your fiscal intermediary in order to show utilization of resources; however, it will trigger OCE edit 27 (incidental services only) if no other reimbursable services are reported. If no other services are reported with the rabies vaccination, with appropriate documentation, you may be able to add a low-level E/M code based upon your facility's criteria.

Note that an upcoming CCI edit (9.3) effective January 1, 2004, will be in direct contradiction to the CMS final rule in which codes 90782-90788 reported with Q0081, Q0083, or Q0085 will trigger unbundling edits that will not allow a modifier to bypass the edit. We strongly suggest that you contact your own FIs for clarification regarding this edit.

PAY PER VIEW: With few exceptions, providers must submit all claims to Medicare electronically as of October 16, according to an interim final rule issued August 15 by the Centers for Medicare & Medicaid Services (CMS).

Click HERE to read more. The cost is $10. Strategies for Health Care Compliance subscribers have free access via their online subscriptions.

ASK THE EXPERT: Is it true that as a result of HIPAA CMS is not allowing ICD-9 procedure codes for outpatient claims?

Click 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.

Advisory group recommends adoption of ICD-10

The National Committee on Vital and Health Statistics (NCVHS) voted November 5, 2003, to recommend that the Department of Health and Human Services (HHS) adopt the ICD-10 coding standards "as replacement for current uses of ICD-9-CM volumes 1, 2, and 3." The committee adopted a letter of recommendation that calls for HHS Secretary Tommy G. Thompson to "initiate the regulatory process for the concurrent adoption" of the two classification systems. If adopted, the ICD-10 codes would become the required standard under the administrative simplification provisions of the Health Insurance Portability and Accountability Act.


Are you ready to use the new 2004 ICD-9-CD codes?

We have just what you need to get ready. It's the 2004 ICD-9-CD Training Kit. You get a trainer's package with a plan to help educate staff on all of the changes, along with flyers and a Q&A section. You also get 10 coder handbooks, which include reference guides and clinical explanations for each new code so coders understand why and how each code should be applied. It's a steal of a deal at only $99. If you need more, we'll sell you additional coder handbooks in packages of 10.

Ordering is easy. Just CLICK HERE or call our customer service department at 800-650-6787. Be sure to mention Source Code EB23346A.

Take two!

Hours that is, and join us for the audioconference that will get you ready to face 2004 with confidence. We're changing our usual format for "APC Task Force: How to Implement the 2004 Final OPPS Rule" and running it as a two-hour program. There is so much important information to share, and you'll probably have questions. We want to help you to start the new year off right!

We'll look for you on Tuesday, December 9 beginning at 1 p.m. Eastern. Bring your lunch, a pad of paper, the materials package we'll send, along with your questions.

To register or to learn more, CLICK HERE or call our Customer Service Team at 800-650-6787. Please mention source code EZ23521A when you call.

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