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APCs Insider

This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations. Topics include the outpatient code editor (OCE), complex coding issues, beneficiary co-payment discounting, and cross-department APCs tracking.

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Issue 51, December 28, 2007

• Understand the Medicare, Medicaid and SCHIP Extension Act of 2007

  QUESTION: I've heard that President Bush plans to sign legislation to extend the current treatment...

• Tip of the Week: Use one biopsy code regardless of how many biopsies physician took

  If a physician takes multiple biopsies (more than 40), report the biopsy code only once, regardless...

• Pay-Per-View: Tips to help tackle MS-DRG challenges, new CC system

  The change to the Medicare Severity DRG (MS-DRG) system brings with it a host of challenges-the...

• Trivia of the Week

  The first New Year's Eve ball drop occurred in New York City's Times Square in what year?

Issue 50, December 21, 2007

• Stay up-to-date with 2008 pathology billing changes

  QUESTION: Is it true that as of January 1, 2008, pathologists will no longer be able to bill...

• Tip of the Week: Watch for inappropriate denials of bone mass measurement claims

  CMS announced that some Medicare contractors have inappropriately denied hospital claims for bone...

• Pay-Per-View: Understand clinical perspective about how atrial fibrillation gets a bum rap as ’cause of death’

  People don't die of atrial fibrillation. Okay, that's not always true. But on paper, it appears as...

• Trivia of the Week

  On average, how many hours per day do cats sleep?

Issue 49, December 14, 2007

• Note CMS' payment differences between diagnostic and therapeutic radiopharmaceuticals in 2008

  QUESTION: How will CMS handle payment for radiopharmaceuticals in 2008?

• Tip of the Week: Understand EP procedure notes in order to assign correct codes

  To ensure HIM/coding staff understand electrophysiol­ogy (EP) procedure notes and assign...

• Pay-Per-View: Identify aneurysm location, shape, and type to ensure correct coding

  An aneurysm occurs when an artery becomes filled and dilated with blood because of the pressure of...

• Trivia of the Week

  Who is the Hebrew warrior that’s commemorated in Hanukkah?

Issue 48, December 7, 2007

• Understand lack of 2008 E/M national guidelines

  QUESTION: Can you explain the E/M guidelines outlined in the 2008 OPPS final rule? Why don't we...

• Tip of the Week: Know when to report CPT code 45383 versus 45384

  If you're removing a polyp, and you report CPT code 45383, ensure that the physician documented...

• Pay-Per-View: Go with the flow when coding EP exams

  Electrophysiology (EP) exams can resemble a sixth grader’s Frankenstein science project: They...

• Trivia of the Week

  When Walt Disney first invented Mickey Mouse, what was the first thing Walt wanted to name him?

Issue 47, November 30, 2007

• Distinguish between diagnostic and screening colonoscopies

  QUESTION: During a scheduled colonoscopy, the physician only reaches the sigmoid. Would you code...

• Tip of the Week: Report atrioventricular blocks based on the degree of the block

  To code an AV block, report codes based on the degree of the block. The AV block ICD-9 codes range...

• Pay-Per-View: NDC reporting requirement creates burden for hospitals

  The use of the national drug code (NDC) to report medications is not a new concept for Medicaid...

• Trivia of the Week

  Who said the following quotation? "Anything that has real and lasting value is always a gift from...

Issue 46, November 16, 2007

• Understand how payment for observation services will change in 2008

  QUESTION: Can you explain how payment for observation services will change as of January 1 as...

• Tip of the Week: Understand composite APCs under the 2008 OPPS final rule

  Take note that in the final rule, CMS created the following four new composite APCs...

• Pay-Per-View: Coordinated staff, documentation play vital roles in POA reporting

  Although many providers are bracing themselves for yet another regulation to satisfy the...

• Trivia of the Week

  In what year did the movie "Close Encounters of the Third Kind" debue?

Issue 45, November 9, 2007

• Consider pre-filled saline syringes to be packaged supplies

  QUESTION: Can we bill for the pre-filled saline syringe that a provider uses at the conclusion of...

• Tip of the Week: Stay up-to-date with packaging changes outlined in the OPPS final rule for 2008

  In addition to finalizing most of its proposals, CMS created a new type of APC (a composite APC...

• Pay-Per-View: ICD-9-CM guidelines revise coding of sepsis, pain management

  The new ICD-9-CM coding guidelines do not contain any major, sweeping changes, but they do include...

• Trivia of the Week

  What is the title of the "lost" Pink Floyd album?

Issue 44, November 2, 2007

• Do not report emergency department (ED) E/M codes in addition to critical care codes on the same claim

  QUESTION: I was wondering if you could address when it is appropriate to bill ED E/M codes...

• Tip of the Week: Understand what constitutes observation services

  Always keep in mind that observation services do not include those services that providers render...

• Pay-Per-View: Work-flow assessment helps one facility implement document imaging

  Trying to document HIM work-flow is like trying to capture your morning routine on paper. Much of...

• Trivia of the Week

  Only two U.S. states have record highs no greater than 100 degrees. One state is Alaska. What is...

Issue 43, October 26, 2007

• Tackle sequential and multiple infusion drug coding

  QUESTION: When billing for IV infusions, do you add each of the infusion times together and bill...

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

  There are circumstances in which you should establish written policies and procedures as to how you...

• Pay-Per-View: Observation coding and billing scenarios demystified

  Establishing definitions for what constitutes observation time has been the cause of much confusion...

• Trivia of the Week

  Mostly known as a hero, Vlad Dracula was born in a noble family. His surname comes from the order...

Issue 42, October 19, 2007

• Be on the lookout for status indicator "N" versus "Q"

  QUESTION: Our respiratory therapy department performs oxygen saturations with exercise (CPT code...

• Tip of the Week: Review the October OPPS quarterly update

  Dave Fee, MBA, marketing manager for outpatient products at 3M Health Information Systems in...

• Pay-Per-View: Educate or retrain your coding and clinical staff members on documentation needs to prevent ED revenue loss

  Medical professionals can identify with the concepts of meticulousness, consistency, and accuracy...

• Trivia of the Week

  What ends every year at 2:00 a.m. local time on the last Sunday of October?

Issue 41, October 12, 2007

• Bill 36430 regardless of where the patient was admitted

  QUESTION: A doctor receives laboratory test results on a post transplant patient. The doctor tells...

• Tip of the Week: Understand entry points for observation admission

  In order to ensure complete observation documentation, your facility should think about the entry...

• Pay-Per-View: CMS announces proposed quality specifications

  CMS released data specifications for its 2009 proposed outpatient quality reporting measures in...

• Trivia of the Week

  According to superstition, what happens to a woman who sees a goldfinch flying overhead on...

Issue 40, October 5, 2007

• Understand when to bill for pulse oximetry separately

  QUESTION: I would like to know whether you have any information on when we can bill "pulse ox...

• Tip of the Week: Perform a financial impact analysis of the 2008 proposed OPPS rule

  Hugh E. Aaron, MHA, JD, CPC, CPC-H, senior vice president of compliance and regulatory...

• Pay-Per-View: Don’t let interventional radiology block your reimbursement

  The peripheral vascular system is one of the most complex areas of medicine to code and bill...

• Trivia of the Week

  Which of the following jobs is the president responsible for? To write laws on which Congress...

Issue 39, September 28, 2007

• Query manufacturers for HCPCS code advice as needed

  QUESTION: I have a question regarding HCPCS code C1787 (Patient programmer, neurostimulator). Is...

• Tip of the Week: Know rule of thumb for coding

  The rule of thumb when it comes to coding IR procedures is for each vascular family that a...

• Pay-Per-View: Don’t overlook the new ASC payment system

  Like many hospitals in the healthcare industry, your hospital/outpatient facility may be...

• Trivia of the Week

  In the game Monopoly, which of the following squares is between the "Pennsylvania Railroad" and...

Issue 38, September 21, 2007

• Carefully review inpatient-only list according to year

  QUESTION: Where can I find the inpatient-only list for surgery? We have recently opened an...

• Pay-Per-View: CMS proposes shift toward extensive packaging

  On July 16, CMS released the 2008 OPPS proposed rule, which included a dramatic shift in the...

• Trivia of the Week

  According to the University of California at Berkley Wellness Letter, which of the following do...

Issue 37, September 14, 2007

• Consider pre-filled saline syringes packaged supplies

  QUESTION: Can we bill for the pre-filled saline syringe that the provider uses at the conclusion of...

• Tip of the Week: Understand how to code and bill common IR procedures

  In order to code and bill for interventional radiology (IR) procedures, coders must focus on the...

• Pay-Per-View: New E/M guidance won’t ruffle feathers

  According to the 2008 OPPS proposed rule, hospitals across the country have proven themselves more...

• Trivia of the Week

  What animal's sense of taste is approximately 12,000 times more sensitive than a human's?

Issue 36, September 7, 2007

• Report chest x-rays, EKGs, and other procedures separately from critical care

  QUESTION: I would like to know how others are using the critical care codes in the emergency...

• Tip of the Week: Comment on the 2008 OPPS proposed rule

  You are in charge of analyzing the 2008 OPPS proposed rule and sharing relevant information with...

• Pay-Per-View: Steer clear of sinus surgery coding slipups

  Ear, nose, and throat (ENT) physicians need a rock-solid knowledge of anatomy and the skill to...

• Trivia of the Week

  Hantavirus causes a deadly haemorrhagic fever in North America. How is the hantavirus spread to...

Issue 35, August 31, 2007

• CPT code 43280 not on inpatient-only list

  CPT code 43280 not on inpatient-only list

• Tip of the Week: Narrow your interpretation of modifier -59

  It seems like modifier -59 (distinct procedural service) is the black sheep of the coding industry...

• Pay-Per-View: Haste doesn't necessarily make waste

  Before you try to report unused supplies, you should have a basic underlying knowledge about why it...

• Trivia of the Week

  What legendary British rocker said (in reference to David Bowie): "Never wear a new pair...

Issue 34, August 24, 2007

• Assign proper E/M levels for new versus established patients

  QUESTION: I work in an urgent-care setting. How do I distinguish between new and established...

• Tip of the Week: Steer clear of sinus surgery coding slipups

  Otolaryngologists, commonly known as ear, nose, and throat physicians (ENT), must complete a...

• Pay-Per-View: Wholesale OPPS packaging

  On July 16, CMS released the 2008 OPPS proposed rule earlier than expected, and to the surprise of...

• Trivia of the Week

  Name the novel that opens with this first line: "On the morning of August 8, 1965, Robert Kincaid...

Issue 33, August 17, 2007

• Trivia of the Week

  Trivia of the Week

• Pay-Per-View

  Trying to document HIM work-flow is like trying to capture your morning routine on paper. Much of...

• Tip of the Week

  Although most hospitals are aware of the recovery audit contractor (RAC) demonstration project...

• With comment period ending Sept. 14, prepare your comments

  QUESTION:  The 2008 OPPS proposed rule seems very detailed and lengthy. What would you...

Issue 32, August 10, 2007

• Get ready for payment impact of status indicator

  Question: Could you explain the significance of status indicator "Q" (SI "Q") services, as detailed...

Issue 31, August 3, 2007

• Answer appropriate questions before billing for IV antibiotics and dressing change

  QUESTION: I have a question regarding an article in the June 1, 2007 issue of the APCs Weekly...

• Tip of the Week: Create a to-do list before you implement documentation templates in your facility

  Documentation templates can accelerate the coding process and help fulfill the coder's mantra of...

Issue 30, July 27, 2007

• Trivia of the Week

  Trivia of the Week

• Pay-Per-View

  Pay-Per-View: Coding Clinic advice for aborted stroke cases sparks debate

• Review your E/M guidelines in light of new CMS guidance

  Review your E/M guidelines in light of new CMS guidance

• Tip of the Week: Check your 2007 reimbursement for specific drugs

  Tip of the Week: Check your 2007 reimbursement for specific drugs

Issue 29, July 20, 2007

• Watch for reimbursement changes for vaccines

  Watch for reimbursement changes for vaccines

• New OPPS proposed rule pushes wholesale packaging

  New OPPS proposed rule pushes wholesale packaging

Issue 28, July 13, 2007

• Don't bill 59025, 76818 separately without separate physician orders

  QUESTION: We have a question about billing for fetal non-stress testing. A pregnant woman reports...

• Correction

  Correction: APCs Weekly Monitor of June 29, 2007

• Tip of the Week: Watch for problematic fields on UB-04

  Tip of the Week: Watch for problematic fields on UB-04

Issue 27, July 6, 2007

• Revenue codes 361, 510, and 761

  Revenue codes 0361, 0510, and 0761 are valid options for billing wound care clinic services

Issue 26, June 29, 2007

• Tip of the Week: Watch for 'complications of care' that didn't occur

  Tip of the Week: Watch for 'complications of care' that didn't occur

• Understand the Medicare three-day payment window

  Understand the Medicare three-day payment window for recurring accounts

Issue 25, June 22, 2007

• Tip of the Week: Preauthorize stereotactic radiosurgery procedures

  Tip of the Week: Preauthorize stereotactic radiosurgery procedures

• Prepare for mandatory present on admission reporting

  Prepare for mandatory present on admission reporting

Issue 24, June 15, 2007

• HCPro, Inc., is pleased to introduce its new collection of 2008 Coding Manuals

  HCPro, Inc., is pleased to introduce its new collection of 2008 Coding Manuals

• Append modifier -52 for reduced service echocardiogram

  Append modifier -52 for reduced service echocardiogram

Issue 23, June 8, 2007

• Hospitals are not bound by InterQual criteria for determining patient status

  I have a question about what to do when a physician writes orders to admit a patient to the...

• Tip of the Week: Make sure your payers are aware of the UB-04 changes

  Tip of the Week: Make sure your payers are aware of the UB-04 changes

Issue 22, June 1, 2007

• Pay-Per-View

  HIM and coding departments strive to find a way for their coders to produce a high volume of work...

• Do not bill E/M with drug administration charge

  Do not bill E/M with drug administration charge when an infusion is the sole reason for the visit

• Tip of the Week: Comply with the Deficit Reduction Act

  Tip of the Week: Comply with the Deficit Reduction Act

Issue 21, May 25, 2007

• Hospitals must absorb costs from outsourced companies

  Hospitals must absorb costs from outsourced companies

• Tip of the Week: Consider dedicating coding staff to complex procedures

  Tip of the Week: Consider dedicating coding staff to complex procedures

Issue 20, May 18, 2007

• CMS denies payment for overseas contractors who read radiology films

  CMS denies payment for overseas contractors who read radiology films

• Tip of the Week

  Tip of the Week: Form a RAC team to help prepare for national implementation of program

Issue 19, May 11, 2007

• Follow 72-hour and 24-hour rules

  QUESTION: A patient presents as an outpatient to our hospital for a colonoscopy. Our clinic...

Issue 18, May 4, 2007

• Tip of the Week: Use revenue code 450 with Type B visits

  Tip of the Week: Use revenue code 450 with Type B visits

• Use these tips to properly code anal fissure

  Use these tips to properly code anal fissure

Issue 17, April 27, 2007

• Tip of the Week

  Dave Fee, MBA, marketing manager, outpatient products for 3M Health Information Systems in Salt...

• Consider the following guidance and tips when billing IVIG

  Consider the following guidance and tips when billing IVIG

Issue 16, April 20, 2007

• Report anesthesia charge using revenue code 370 and no HCPCS

  In the moderate sedation codes section of the CPT Manual (99143-99150), the preface states that the...

• Tip of the Week: New pacemaker CPT codes

  New pacemaker CPT codes do not include pulse generator insertion: Be on the lookout for two codes...

Issue 15, April 13, 2007

• Trivia of the Week

  Trivia of the Week

• Pay-Per-View: Improve accuracy with clinically-minded coding

  Coming changes, such as the present-on-admission (POA) indicator and severity-based DRGs, mean that...

• Provider Roundtable currently seeking new members

  Provider Roundtable currently seeking new members

• Count observation time when the patient is moved to the floor

  QUESTION: We have come across cases in which the physician performs either a surgery or procedure...

• Tip of the Week: Use these strategies to integrate coders

  Getting new inpatient coders to become productive members of your department is a challenge. "It's...

Issue 14, April 6, 2007

• Only count critical care time once when multiple staff are involved

  Only count critical care time once when multiple staff are involved

• Tip of the Week: Overturn CCI edits with 33223, 33222

  Tip of the Week: Overturn CCI edits with 33223, 33222: Use of modifier -59 warranted when physician...

Issue 13, March 30, 2007

• Consider these options when billing telemetry daily monitoring

  Q: Can our hospital code and bill telemetry daily monitoring in conjunction with a chest pain...

• Tip of the Week: Follow these drug administration guidelines

  Be aware of the following concepts/guidelines when coding drug administration claims:

Issue 12, March 23, 2007

• Do not separately bill 'soft goods' through a home medical supplier

  Do not separately bill 'soft goods' through a home medical supplier

• Tip of the Week: Keep in compliance with modifier -25

  Tip of the Week: Keep in compliance with modifier -25

Issue 11, March 16, 2007

• Report 90768 for concurrent infusion of non-chemotherapy drug

  Report 90768 for concurrent infusion of non-chemotherapy drug

• Tip of the week: Bill packaged services

  Tip of the week: Bill packaged services

Issue 10, March 9, 2007

• Use unlisted code 96549 to report concurrent chemotherapy

  Use unlisted code 96549 to report concurrent chemotherapy

Issue 9, March 2, 2007

• An explanation for drug administration CPT codes 'hierarchy'

  An explanation for drug administration CPT codes 'hierarchy'

Issue 8, February 23, 2007

• Report 90774 or 90775 as appropriate for bolus of normal saline

  Report 90774 or 90775 as appropriate for bolus of normal saline

Issue 7, February 16, 2007

• Do not report 51701 with P9612 for specimen collection

  Do not report 51701 with P9612 for specimen collection

Issue 6, February 9, 2007

• Ensure separate billing of Type A vs. Type B ED patients

  QUESTION: I am seeking clarification on how to identify Type A and Type B ED services. For example...

Issue 5, February 2, 2007

• Bill one initial drug administration code per encounter, regardless of duration

  Bill one initial drug administration code per encounter, regardless of duration

Issue 4, January 26, 2007

• Pay attention to hierarchy of CPT codes when reporting IV infusions with IV push

  Pay attention to hierarchy of CPT codes when reporting IV infusions with IV push

Issue 3, January 19, 2007

• Do not use pathology measurements to report a lesion's size

  Do not use pathology measurements to report a lesion's size

• Tip of the Week: Understand how the ASC final rule will affect your outpatient facility

  Andrea Clark, RHIA, CCS, CPC-H, president of Healthcare Revenue Assurance Associates, Inc., in...

Issue 2, January 12, 2007

• Bill comprehensive and component x-rays using modifier -59

  Bill comprehensive and component x-rays using modifier -59

Issue 1, January 5, 2007

• Take steps to prepare for new Medicare preventive screening benefit

  Could you tell me about the new preventive screening benefit from CMS?

Issue 27, July 6, 2007

• Tip of the Week: Beware of common postacute transfer pitfalls

  Tip of the Week: Beware of common postacute transfer pitfalls

Issue 6, August 8, 2007

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