Health Information Management

Tip of the Week: Identify scenarios in which you'll charge for supplies used in discontinued procedures

APCs Insider, October 26, 2007

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There are circumstances in which you should establish written policies and procedures as to how you decide to charge for supply items when the provider discontinues the procedure. Without performing an in-depth analysis, it does not appear that CMS uses the charges from discontinued procedures in the database of claims that generate the APC weights. Thus, if you choose not to charge for these items, then there is really no effect, and you may gain a little in public relations when the patient receives a bill without the charges for items that, from the patient's perspective, were never used.

Treat true pass-through items differently. For example, if you provide nuclear medicine services with A9500 (Tectinium), you will generally obtain a specific vial or vials of the radiopharmaceutical slightly in advance of the service.

These vials are typically specific to the patient and must be used on schedule. Otherwise the half-life of the radioactivity will render the vials useless. If a procedure is discontinued, then questions exist about how to code and bill for these types of items. Hospitals must study these types of situations and draft policies and procedures about how they have decided to address such issues. There does not appear to be hard and fast answers for every type of situation.

(The above tip appeared in the November 2007 issue of Briefings on APCs).



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