Health Information Management

Failed Foley insertion

APCs Insider, November 21, 2003

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Friday,
November 21, 2003
Vol. 4, No. 46



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THE MONITOR'S ADVISORY BOARD

Keith Siddel
MBA, PhD (c),
president, CEO
HRM, Hospital Resource Management

Andrea Clark
RHIA, CCS, CPCH
president
Health Revenue Assurance Associates

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

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

Julia R. Palmer
MBA, RHIA, CCS,
president, Health Information Management Division
HRM

Valerie Rinkle
MPA
revenue cycle director
Asante Health System


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Your APCs Weekly Monitor is a free weekly e-zine from HCPro, publisher of both Briefings on APCs, the monthly newsletter devoted entirely to managing under APCs, and APC Answer Letter, which answers 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 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 its corresponding answer are delivered to your inbox every Friday.


TODAY'S TOPIC: Failed Foley insertion

QUESTION: For a patient seen in the ED, the documentation states "two failed attempts to insert Foley catheter by nurse, and no success with doctor attempt." The patient was then admitted. Should the failed attempt be coded as 51702-52 for the supply charge for the Foley material?

ANSWER: For a failed attempt to insert an indwelling Foley catheter, use CPT code 51702 with modifier -52. The OPPS rules state that modifier -52 may be used when significant use of facility resources/supplies is documented. CMS has not assigned an APC to 51702, but it may be reported. If the patient is admitted to the hospital, as noted above, no ED services will be paid separately but rather rolled into the diagnosis-related group (DRG) for the inpatient stay (excluding situations in which costs may be reported for outlier payments).

For an unsuccessful attempt followed by a successful catheter insertion, use code 51703 "complicated catheter insertion." The CCI edits list 51702 as a component code of 51703. You cannot override this edit (modifier indicator status 0). The OCE editor shows edit 27 "only incidental service reported" because the OPPS does not have an APC for either code. Remember to code for your ED visit in addition to the attempted Foley insertion.

However, if the reason for the Foley insertion is to obtain a urine sample for diagnostic testing, assign HCPCS code P9612 for reporting catheterization for specimen collection.


PAY PER VIEW: Prepare for OPPS changes with in-house impact analysis

Large or small, rural or urban, every hospital has the same question when it comes to new regulations: How will the changes affect reimbursement? To plan and meet financial goals, every facility needs to know how each new rule or program memorandum will change its bottom line.

Click HERE to read more. The cost is $10. Briefings on APCs subscribers have free access via their online subscriptions.

ASK THE EXPERT: When a patient signs a form to allow a guardian or proxy to make health care decisions, can this same form be used to consent to research?

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.


EDITOR'S CHOICE

APC Coding: Special offer on new courses from Lolita M. Jones

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To take advantage of this special offer, or order any of the courses individually, CLICK HERE or call our customer service department at 800-650-6787. Be sure to mention Source Code EP23656A.


Master, then implement the 2004 CPT codes

A new year means new CPT codes. You probably don't have time to research all of the changes slated for 2004 (there are more than 550), analyze their impact, educate staff, and implement the changes while you do your regular job. Relax, we'll do the work for you. Join us on December 2 beginning a 1 p.m. Eastern for "Mastering CPT Changes for 2004." This 90-minute live audioconference includes examples of the changes and their impact on documentation, billing, and revenue, as well as a live question-and-answer session.

To register or to learn more, CLICK HERE or call our Customer Service Team at 800/650-6787. Please mention source code EZ23501B when you call.



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