Health Information Management

G0168 rejected by claims scrubber

APCs Insider, January 20, 2006

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

G0168 rejected by claims scrubber

QUESTION: In the 2005 OPPS final rule, CMS assigned a status indicator N to HCPCS code G0168, Wound closure utilizing tissue adhesive(s) only. This means that it's a packaged service and should be reported as a supply or product.

However, as of January 1, 2006, our claims scrubber is rejecting claims with G0168. Could you explain what has happened? Should we continue to report Dermabond?

ANSWER: Based on the January 4, 2006 release of Addendum B (the latest edition of APC payments for CPT codes), CMS has assigned status indicator B to G0168. This means the OPPS will not recognize this code when you submit it on an outpatient hospital Part B bill type (12x, 13x, and 14x).

Even though you cannot submit G0168, it does not imply your facility should discontinue reporting its wound supply resources completely. Therefore, facilities have two choices:

1. Build your Dermabond supply into the overall wound repair procedures charges; or

2. Separately identify Dermbond resources with revenue code 27X and the associated charge, along with a separate wound repair charge. Report the separate wound repair charge with revenue code 450.

Regardless of your choice, the line item will be packaged into the overall payable APC.



Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular