APCs Weekly Monitor  | HCPro

In this issue - April 27, 2007

  1. Consider the following guidance and tips when billing IVIG

  2. Tip of the Week: Don't replace modifier -50 with -LT/-RT

  3. Pay-Per-View: Audit your ED to minimize potential revenue loss: Target trouble spots with focused review

  4. Trivia of the Week

Upgrade to Briefings on APCs and save 10%  | 

View Web Version

 |  Archives  |  Send to a colleague  |  Subscribe for FREE  |

Please add our address apcmonitor@list.hcpro.com to your e-mail address book to ensure you receive your eNewsletter issues.

APCs Weekly Monitor
April 27, 2007
Send to a colleague Send to a colleague
Subscribe for FREE Subscribe for FREE

APCs Weekly Monitor is a free weekly e-zine from HCPro, Inc., publisher of both Briefings on APCs, the monthly newsletter devoted entirely to managing under APCs, and APC Answer Letter, which answers readers’ questions about coding for APCs.

The Monitor is a complimentary companion publication with a specific mission: To provide answers to your tough questions about APC regulations.

UPGRADE to a premium subscription of Briefings on APCs and save 10% for being an APCs Weekly Monitor subscriber.

Existing Briefings on APCs subscribers, renew your subscription.

Consider the following guidance and tips when billing IVIG

Question: Should we code and charge intravenous immunoglobulin (IVIG) as a chemotherapy drug as we do for Remicade®, or should we code and charge it as an IV infusion? Is there a compiled list of biologicals that we should code and bill as chemotherapy?

Answer: IVIG has been shown to be an effective treatment for a variety of autoimmune, infectious, and idiopathic diseases. Review your FI's local coverage determination (LCD) to identify appropriate and specific diagnoses for this covered service, if applicable. Different IVIG preparations are manufactured in the U.S., including Gammagard S/D, Gammar-IV, Gamimune-N, Iveegam, Gamunex, and Sandoglobulin®. Review the manufacturers' Web sites to help assign proper HCPCS codes for this drug.

Use the following HCPCS codes to report this detailed drug. Pay specific attention to the long descriptor and dosage to properly report correct units to your FI:

  • J1562: Injection, immune globulin, subcutaneous, 100 mg
  • J1565: Injection, respiratory syncytial virus immune globulin, intravenous, 50 mg
  • J1566: Injection, immune globulin, intravenous, lyophilized (e.g., powder), 500 mg
  • J1567: Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), 500 mg

When staff administer IVIG as a plasma protein replacement therapy for immune deficient patients to bolster their decreased or abolished antibody production capabilities, report the following codes as appropriate:

  • 90765: Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour; and
  • 90766: Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure). 

It is imperative that clinical documentation supports the total number of hour(s) of IVIG administration you bill. In other words, the documentation should contain the time that staff started and completed the IVIG treatment. Note that starting January 1 of this year, CMS reimburses for all additional hours of hydration, therapeutic, and chemotherapy infusion.

We recommend that you contact your FI for a complied list of biologicals or monoclonal antibodies, as CMS has not released such a list. Look to your pharmacy and oncology departments for additional assistance with classification. 

Final tip: CMS continues to separately reimburse HCPCS code G0332 (Preadministration-related services for intravenous infusion of immunoglobulin, per infusion encounter) in 2007. You can report G0332 in addition to the administration codes listed above each time the patient presents for this service. According to the April 2007 OPPS Addendum B, G0332 maps to APC 1502, paying $75 nationally.

Back to top

Tip of the Week: Don't replace modifier -50 with -LT/-RT

Dave Fee, MBA, marketing manager of outpatient products for 3M Health Information Systems in Salt Lake City says at least one FI has allowed hospitals to report a bilateral procedure CPT code with both modifier -LT (left side) and  -RT (right side) together on a single line item, instead of modifier -50 (bilateral procedure). "It's an incorrect practice to use an -LT and an -RT modifier instead of -50," Fee says.

He also notes the negative financial implications: The outpatient code editor (OCE) edits for line items with modifier -50, and will pay that line item at 150% of the reimbursement for the procedure. However, a procedure code appended with both -LT and -RT will pay only 100% of the APC reimbursement.

For example, if a physician performed a knee arthroscopy (e.g., 29871, arthroscopy, knee surgical; for infection, lavage, and drainage) on both of the patient's knees, and the hospital reports 29871-LT-RT, they will receive only $1,759.49 (unadjusted payment for APC 0041). But if they correctly reported 29871-50, the hospital would receive $2639.24 (assuming the FI paid 150% of 29871).

And don't assume the outpatient code editor (OCE) will correct the problem for you: "The OCE only looks for modifier -50, it won't tell you that [reporting -LT and -RT] is wrong," says Fee.

(Source: Briefings on APCs, May 2007).

Back to top

Pay-Per-View: Audit your ED to minimize potential revenue loss: Target trouble spots with focused review

Editor's note: This article is the first in a two-part series. Stay tuned for part two in the June issue of Briefings on APCs, which will provide tips to help solve revenue loss in your ED.

The ED is extremely vulnerable to lost revenue, and experts say most hospitals routinely underreport their outpatient charges.

Compounding these problems is the busy and overcrowded condition of the average ED, says Glenn Krauss, RHIA, CCS, CCS-P, CPUR, an independent consultant in Maryville, TN. "Your average ED is a sieve for revenue," he says.

The best way to stem the flow of lost dollars is a targeted review of claims and focused education on proper documentation, says Diane R. Jepsky, RN, MHA, LNC, president and CEO of Jepsky Healthcare Associates in Sammamish, WA. Before you take steps to get your ED back in financial order, Jepsky and Krauss say you must identify the endemic coding/billing problems in a typical ED.

Click HERE to read more. Briefings on APCs subscribers have free access via their online subscriptions.

Back to top

Trivia of the Week

Airline trivia: The massive double-deck Airbus A380 is the world's largest airliner. How many passengers does it seat?

A. 325

B. 460

C. 555

D. 1,200

Think you know the answer? E-mail senior managing editor Brian Murphy, and if you're one of the first five to answer correctly you'll win a free three-month trial to the HCPro newsletter of your choice!

Last week's question: What subcompact car manufactured by Ford Motors in the 1970's was infamous for its alleged susceptibility to fires and explosions in the event of a rear-end collision?

Answer: The Pinto

Back to top


Coding injections and infusions just got a lot easier

Hospitals have long struggled under complicated guidelines for coding injection and infusion services. But those days are over. Now, using a simple coding decision tree as your guide, you can master coding for these common procedures without having to master complex coding guidelines.

The Injections and Infusions Coding Toolkit, developed by the staff at The University of Texas M. D. Anderson Cancer Center, takes the guesswork out of selecting the initial service and deciding which codes can be reported in combination with other codes.

For more information or to order your copy, visit HCPro's Healthcare Marketplace or call the Customer Service Department at 800/650-6787 and mention Source Code EZINEAD.


If you have a question about APC coding that you would like addressed in the Monitor, send us an e-mail.

Each week, our team of experts answers a question that will appeal to the majority of readers. The elected question and its corresponding answer are delivered to your inbox every Friday.


Volume 8 Issue 17

HCPro, Inc.

200 Hoods Lane
PO Box 1136
Marblehead MA 01945


$subst('list.descshort') © 2007 HCPro, Inc. You have permission to forward $subst('list.descshort'), in its entirety only, to your colleagues, provided this copyright notice remains part of your transmission. To subscribe to $subst('list.descshort'), please send an email to: owner-$subst('List.Name')@hcpro.com and type "subscribe (your e-mail address)" in the body. All other rights reserved. None of this material may be reprinted without the expressed written permission of HCPro, Inc.

Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions. Users of this service should consult attorneys who are familiar with federal and state health laws.

HCPro is not affiliated in any way with The Joint Commission, which owns the JCAHO and Joint Commission trademarks.

For $subst('list.descshort') sponsorship/advertising opportunities, please contact Margo Padios, Advertising Sales Manager, at mpadios@hcpro.com or call 781/639-1872, ext. 3145.

If you would like further information about any of HCPro's products, including books, seminars, videos, consulting services, or newsletters please visit www.hcmarketplace.com

You are receiving this message as a subscriber to $subst('list.descshort'). If you would like to unsubscribe, please visit http://www.hcmarketplace.com/unsub.cfm?e=$subst('Recip.EmailAddr') If you do not have web access, please forward this email to: owner-$subst('List.Name')@hcpro.com and type "Remove $subst('Recip.EmailAddr')" in the body.

Copyright 2007 HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945