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