Modifier -PD (diagnostic or related nondiagnostic item or service provided in a wholly owned or wholly operated entity to a patient who is admitted as an inpatient within three days or one day) is now included in the I/OCE, according to January updates detailed in Transmittal 2370 .
Q Addendum B of the APC updates for 2012 indicates the new molecular pathology codes have status indicator E (noncovered service, not paid under OPPS). Our laboratory director said we should report these new codes in addition to the codes that are payable. Can you explain why?
QUESTION: We have a question in regards to hydration that we are trying to figure out. Does the physician specifically have to state in his or her documentation that the IV is for hydration purposes or can a coder figure it out through critical thinking and using the process of hierarchal injection/infusion coding when reading the record? For example, X IV fluids are being used for an antibiotic and after the antibiotic, the IV fluids continue at 125/hr for hydration. Does the physician need to document "for hydration"? Our physicians do not want to write that. Do you have any good advice on this?
In many instances, payers may consider a drug to be self-administered in some circumstances but not in others. As a result, coders must pay special attention to how these drugs are used within their setting. Kimberly Anderwood Hoy, JD, CPC, and Valerie Rinkle, MPA, offer some tips and suggestions for reporting self-administered drugs and determining when the drug is integral to the service.
QUESTION: We are a nondialysis facility, so when a patient is in observation for some other reason and must undergo hemodialysis, we report code G0257 (unscheduled or emergency dialysis treatments for an ESRD [end stage renal disease] patient in a hospital outpatient department that is not certified as an ESRD facility). But how should we code peritoneal dialysis when a patient is in observation or inpatient for other problems? I have received three different codes from different coders. I cannot really find any information on this anywhere.
Perhaps you're familiar with the following scenario: A hospital submits a short-stay inpatient (Part A) claim. An auditor, such as a RAC or MAC, reviews the claim and deems the admission to be not reasonable and necessary due to the hospital billing the wrong setting. The auditor issues a denial for the full amount of the claim. Although the hospital may rebill for certain Part B ancillary services before the timely filing limit, it may not bill for any of the other outpatient services denied as part of the inpatient claim.
Q We're struggling with nursing documentation of stop times for IV infusions (e.g., piggybacks and hydration). The nurses also inconsistently document a patient's return to the unit from diagnostics. We know that CMS now allows us to use average times for common services, and we're interested in considering this approach at my organization. Can you share additional specifics?
Coders can find the largest number of new codes in the pathology and laboratory section of the 2012 CPT® Manual . The AMA added a total of 103 new codes, 101 of which denote Tier 1 and Tier 2 molecular path-ology procedures.
In total, the AMA added 60 new codes throughout the surgery section of the 2012 CPT® Manual , 18 of which appear in the cardiovascular and respiratory system subsections. The AMA also revised 86 codes and deleted 48 codes in the surgery section.
Self-administered drugs present a significant issue for coders, especially when considering how they may or may not be covered by Medicare Part B. In many instances, payers may consider a drug to be self-administered in some circumstances but not in others. As a result, coders must pay special attention to how these drugs are used within their setting.
CMS decided not to cap outpatient payment rates for cardiac resynchronization therapy defibrillator procedures at the standardized inpatient rate as part of the calendar year 2012 Outpatient Prospective Payment System final rule. In addition, CMS finalized several changes regarding payments for 11 cancer centers, drug payment calculations, and physician supervision. Jugna Shah, MPH, and Kimberly Anderwood Hoy, JD, CPC, explain the changes facilities will see in 2012.
QUESTION: The 2012 CPT ® Manual includes the typical time physicians spend at the bedside and on the patient’s hospital floor or unit for initial observation care codes 99218, 99219, and 99220. Do these codes only apply when the counseling and/or coordination of care support the respective 30/50/70 minutes of time? Do you know if CMS has published any new guidelines related to these times?
Our coding experts answer your questions about determining ED visit level, coding open reduction and internal fixation of a radius fracture, and coding image-guided minimally invasive lumbar decompression.
Fortunately for providers, CMS decided not to cap outpatient payment rates for cardiac resynchronization therapy defibrillator (CRT-D) procedures at the standardized inpatient rate. The agency announced its decision as part of the CY 2012 OPPS final rule released November 1, 2011.
