Health Information Management

Category C codes make a comeback

APCs Insider, December 4, 2003

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December 5, 2003
Vol. 4, No. 47


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HRM, Hospital Resource Management

Andrea Clark
Health Revenue Assurance Associates

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HSS, Inc.

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University Colorado Hospital

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Director of HIMS
St. Joseph's Medical Center

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Corporate Compliance

Julia R. Palmer
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Valerie Rinkle
revenue cycle director
Asante Health System




Today's topic: Category C codes make a comeback

Yes, it's true--CMS has reactivated C codes for device categories for optional use beginning in 2004. You may wonder why hospitals should go the trouble of reporting C codes if Medicare doesn't require it. Read on to find out why our experts believe you should make a New Year's resolution to reintroduce them to your chargemaster.

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 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: Resurrection of the C-Codes

QUESTION: Is it true in the final rules for 2004 APC reimbursement methodology Category C codes are being resurrected? When is that required?

ANSWER: Yes, within the final 2004 APC rules published November 7, 2003, CMS has reactivated C codes for device categories as they existed on December 31, 2002.

According to the Federal Register, the use of the code is not required and will not be enforced. However, hospitals should understand that providing complete and accurate information about the services that were furnished and the charges for those services is fundamental to the establishment of relative weights on which the payment for their services is based.

For 2004, the 95 C code categories will be indicated by status indicator N items and services packaged into APC rates. So, technically they will be paid under OPPS; however, payment is packaged into payment for other services, including outliers. Therefore, there is no separate APC payment.

Although use of C codes is optional, it is important that hospitals realize the significance of complete data capture for CMS to fine-tune future APC reimbursement calculations. CMS reviews all claims data to determine whether an item should be reimbursed in future OPPS updates by following standard criteria set by CMS.

Dust off program memorandums A-01-41, A-01-73, A-01-97, A-02-50, and A-02-129 and begin to resurrect your C codes within your chargemaster. Future reimbursement depends on it.

It is important to review your chargemaster on an ongoing basis to ensure inclusion of all C codes that will be reimbursed by your FI. The most efficient way to conduct this review is to verify the appropriate code each time an item is added to the chargemaster, thus streamlining future periodic reviews.

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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.


Big changes are coming in medical record coding

ICD-10-CM and ICD-10-PCS coding, a series of seven alpha and numeric systems, are on the horizon. It may be two years before you have to implement, but hospitals really have to start getting ready. Changing to ICD-10-CM for diagnosis and ICD-10-PCS for procedures will impact every area that uses coded data in each clinical setting, including HIM, information technology, finance, chargemaster maintenance, and patient registration. They are going to need new internal forms, new computer software, having to train endless numbers of people on the staff, from the coders and billers to the clinical and ancillary services staffs.

We've designed an audioconference to help you learn what the two systems will entail, future requirements of the systems, and what they need to do to prepare for implementation.

Join us for ICD-10: What you need to do NOW to get ready, on Tuesday, January 6, 2004, beginning at 1 p.m. Eastern. For information or to register,CLICK HERE or call our customer service department at 800/650-6787. Be sure to mention Source Code EZ23984B.

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