Ensuring Accuracy: Chargemaster and Outpatient Facility Coding

Transcription

1 Ensuring Accuracy: Chargemaster and Outpatient Facility Coding Catrena L. Smith CCS, CCS-P, CPC, PCS Disclaimer This material is provided as education for coders and other personnel involved in the coding or chargemaster process. Every attempt has been made to ensure that accurate information is presented. Government regulations, as with coding can be everchanging. There can be no assurance that guidance will not change. "CPT copyright 2011 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. 2 1

2 Overview Define Charge Description Master and identify why it is important in the outpatient facility setting Identify elements of a chargemaster Identify items/services that should be reviewed to ensure revenue integrity 3 Includes a list of: Description Services Procedures Charge Description Master 4 2

3 Charge Description Master Includes a list of: Supplies Drugs/biologicals Radiopharmaceuticals 5 Includes a list of: Revenue codes GL number Charge Description Master 6 3

4 Charge Description Master CDM number is the charge code (i.e ) The charge code represents Charge Description CPT or HCPCS code(s) Revenue Codes Charge amount Identifies the department May contain modifiers GL number/gl key 7 Charge Description Master Not all CDM numbers/charge codes are tied to a cost. 8 4

5 Why is the CDM important Aids in timeliness of coding and billing 9 Why is the CDM important Aids in ensuring all necessary elements for a line item are assigned 10 5

6 Caution BEWARE: The most accurate chargemaster does not guarantee that there will be no errors. 11 How does the chargemaster effect outpatient facility coding? Codes are assigned via the CDM 12 6

7 How does the chargemaster effect outpatient facility coding? Procedure(s) unlikely with diagnosis code(s) assigned 13 How does the chargemaster effect outpatient facility coding? Diagnosis code: (Urinary incontinence, unspecified) Procedure code: (sling operation for stress incontinence) *Procedure is unlikely with diagnosis code assigned 14 7

8 How does the chargemaster effect outpatient facility coding? Multiple procedures or services 15 Area of Review Medication administration Injections Infusions Vaccinations 16 8

9 Area of Review Medication Administration Medical records documentation Type of injection/infusion Diagnostic Therapeutic Chemotherapeutic Location Modifier Medication Administration- Hierarchy Chemotherapy Infusions Diagnostic, prophylactic, and therapeutic Pushes Hydration Injections 18 9

10 Area of Review Medication Administration Time documentation Total time Start/Stop time 19 Area of Review Medication Administration Multiple initial services Same clinic location Different clinic locations 20 10

11 Area of Review Medication Administration Drugs/materials Supplies/tubing Local anesthesia 21 Vaccinations Administration Vaccine Product Multiple vaccines Multiple departments Area of Review 22 11

12 Area of Review Vaccinations Carrier rules 23 Vaccinations HCPCS vs. CPT Area of Review 24 12

13 Vaccinations Area of Review Diagnosis code Procedure Code compatibility 25 Transfusion services Laboratory Blood Products Transfusion Area of Review Department (i.e. ED, Clinic, Infusion Center, Observation ward, etc.) 26 13

14 Area of Review Pain Management Injections Procedure type Number of levels Fluoroscopic guidance 27 Area of Review Biopsies Single mass/lesion Multiple masses/lesions Single specimen sent for pathological analysis Multiple specimens sent for pathological analysis 28 14

15 Area of Review Biopsy Documentation Chargemaster 29 Area of Review Destruction of lesions Type of Lesion Location Number treated Diagnosis code-procedure code compatibility 30 15

16 Electrocardiograms Global Technical Professional Area of Review 31 Units of service Documentation Chargemaster Area of Review 32 16

17 Area of Review Modifiers Hard Coded Soft Coded 33 Case Study 1 Patient presents to the hospital outpatient clinic for anti-neoplastic chemotherapy. IV injections of Benadryl and Zofran are given as premeds. Chemotherapy infusion via port is then administered over 3 hours

18 Case Study 1 Patient presents to the hospital outpatient clinic for anti-neoplastic chemotherapy. IV injections of Benadryl and Zofran are given as premeds. Chemotherapy infusion via port is then administered over 3 hours : First hour of Chemotherapy administration, IV infusion x 2: Second and third hour of chemotherapy administration, IV infusion; each addtl. Hour x 2: Two therapeutic/prophylactic or diagnostic injection; each addtl sequential IV push of new substance/drug *Do not report See hierarchy 35 Case Study 2 In the last several months the patient has had a 1 cm flesh-colored nodule on the face with no surface change. Patient also has a couple of actinic keratoses on the ears that I froze today. I did a limited skin check of the scalp, face, neck, and hands. After we did time-out and the patient gave permission, I anesthetized the nodule with Xylocaine, and took an elliptical biopsy. I sutured him with 2 sutures and will have the sutures taken out in 9 days

19 Case Study 2 In the last several months the patient has had a 1 cm flesh-colored nodule on the face with no surface change. Patient also has a couple of actinic keratoses on the ears that I froze today. I did a limited skin check of the scalp, face, neck, and hands. After we did time-out and the patient gave permission, I anesthetized the nodule with Xylocaine, and took an elliptical biopsy. I sutured him with 2 sutures and will have the sutures taken out in 9 days : Destruction of first AK 17003: Destruction of second AK : Separately identifiable biopsy * Modifier -59 is necessary to reflect that the biopsy procedure was not a part of the destruction 37 Case Study 3 A #22-French rigid cystoscope was advanced per urethra into the patient's bladder. A survey with a 30-degree lens disclosed no abnormalities of the bladder or urethra. The polaris stent was immediately visible. A 2 prong grasper was used to retrieve the stent. This was pulled to the urethral meatus, a bentson wire was passed through the stent to the renal pelvis. The stent was then removed. Chargemaster assigned code: (Cystourethroscopy with insertion of indwelling ureteral stent (e.g. Gibbons or double-j type) 38 19

20 Case Study 3 A #22-French rigid cystoscope was advanced per urethra into the patient's bladder. A survey with a 30-degree lens disclosed no abnormalities of the bladder or urethra. The polaris stent was immediately visible. A 2 prong grasper was used to retrieve the stent. This was pulled to the urethral meatus, a bentson wire was passed through the stent to the renal pelvis. The stent was then removed. 1. Stent removal documented, Not stent insertion (Cystourethroscopy with removal of foreign body, or ureteral stent from urethra or bladder; simple) 39 Case Study 4 A 35 y.o. male unrestrained passenger was involved in a MVC. Patient was transported to the ED with multiple injuries. An intermediate repair of the 2.5 cm right forearm laceration was documented. The patient complains of chest pain and headache. The nuclear medicine department performs an EKG. The patient is then taken to xray where a frontal view chest xray and Head CT without contrast are done. Chargemaster assigned codes: 12001: 2.5cm simple laceration repair of forearm 93000: global EKG 71010: frontal view Chest xray 70450: Head CT without contrast 40 20

21 Case Study 4 A 35 y.o. male unrestrained passenger was involved in a MVC. Patient was transported to the ED with multiple injuries. An intermediate repair of the 2.5 cm right forearm laceration was documented. The patient complains of chest pain and headache. The nuclear medicine department performs an EKG. The patient is then taken to xray where a 2-view chest xray and Head CT without contrast are done. Correct codes: 12031: 2.5cm intermediate laceration repair of forearm 93005: EKG, technical component only 71010: Chest xray 70450: Head CT without contrast *For Medicare and other carriers following NCCI, append modifier -59 to Case Study 4 1. EKG code for facility reporting would be for technical service only (93005) 2. Edit received for EKG on same calendar date as the laceration repair? Is a Modifier supported? If so, which one? Which code should it be appended to, if appropriate? 42 21

22 Ensuring Accuracy Create a chargemaster Team 43 Contractual Obligations Ensuring Accuracy 44 22

23 Billing descriptions Ensuring Accuracy 45 Revenue Cycle Training Ensuring Accuracy 46 23

24 Ensuring Accuracy Charge Description Master Review 47 Medical Necessity Ensuring Accuracy 48 24

25 Ensuring Accuracy Electronic Medical Records Hybrid records 49 Ensuring Accuracy Electronic Medical Records Templates 50 25

26 Education is the key Ensuring Accuracy 51 Thank You! 52 26