Facilities may be reluctant to charge for bedside services beyond the room rate because they fear double-dipping. Kimberly Anderwood Hoy, JC, CPC, and William L. Malm, ND, RN, CMAS, discuss what CMS does—and doesn’t—say about charging for ancillary services .
Ancillary department staff may think they don’t need ICD-10 training, but they’re wrong. Lori Purcell, RHIA, CCS, and Kathy DeVault, RHIA, CCS, CCS-P, offer tips for preparing ancillary department staff for ICD-10-CM.
Charging for inpatient ancillary procedures and supplies has always been confusing. "CMS provides very little guidance ... Its theory is that it's up to the provider to figure it out," says Kimberly Anderwood Hoy, JC, CPC, director of Medicare and compliance at HCPro, Inc., in Danvers, Mass.
CMS is reexamining inpatient criteria because it has seen a significant increase in the number of patients spending more than 24 hours in observation. Providers are worried that a Recovery Auditor will deny a short inpatient stay for lack of medical necessity and recoup payment years later. So instead, some facilities place patients in observation for longer time periods.
These days, the healthcare industry is all about the numbers, especially as pay-for-performance becomes more common. Lawrence L. Sanders, Jr., MD, MBA, and Simone R. Gravesande, RN, BSN , review how APR-DRGs work and why all coders should understand them.
To correctly code for radiation oncology services, coders need to understand the various elements of the treatment. Rebecca Vandiver, CPC, CPC-I, and Chandra Stephenson, CPC, CPC-H, CPMA, CPC-I, CANPC, CEMC, CFPC, CGSC, CIMC, COSC, analyze these complex services from a coding perspective.
In ICD-10-PCS, root operations precisely identify the purpose, intent, or objective of a procedure. Cynthia L. Stewart, CPC, CPC-H, CPMA, CPC-I, CCS-P, highlights the specific—and often subtle—differences in the definitions of ICD-10-PCS root operations.
Radiation oncology uses high-energy radiation to shrink or kill tumors or cancer cells with minimal harmful effects to healthy surrounding cells. To correctly code for radiation oncology services, coders need to understand the various elements of the treatment.
More than 8% of the population in the United States (i.e., 25.8 million children and adults) has some form of diabetes, according to the American Diabetes Association. In 2007, diabetes was listed as the underlying cause on 71,382 death certificates. It was a contributing factor on an additional 160,022 death certificates.
The AMA revised the molecular pathology codes in the CPT ® Manual in 2012, but at that time CMS did not adopt the codes as it was still debating whether and how to change the reimbursement system for these services going forward. For CY 2013, CMS elected to recognize the codes, which meant it had to finalize how to pay for them. While CMS did not change pamyent for these services under the Clinical Laboratory Fee Schedule (CLFS) despite industry pressure, its change to the new codes means a change in the payments providers can expect this year and in the future.
