Ortho Pack Using Item This Assignment Is For Some
Explain why this resource would be beneficial to a coder. (read the article below)
Chargemaster, Charge Description Master, CDM, they
all refer to the “list” of your facility’s billable items. Every
hospital has one. Every hospital at one time or another has gone through
a dreaded computer conversion, (when you change from one system to
another) and every hospital should update their CDM on a quarterly basis
for OPPS pass -through items and yearly for the other departments. Does
yours?
So, how is the CDM set up? Each department in your
hospital is assigned to a cost center. Usually the first three or four
numbers in a series of numbers represent that center. Then, the next
four to six numbers represent the specific item that the cost center
bills. In our fictitious St. George Hospital, it could look like this:
222-1234 which translates into 222 (ED cost center)
and 1234 EandM Level 1. EandM Level II would likely be the next number
222-1235, followed by EandM Level III being 222-1236 and so on. Each
item in the ED will be assigned to the 222 cost center and then be
assigned it’s own four digit number.
This method of assigning numbers allows the hospital
to repeat the individual item numbers (if necessary) for other types of
supplies or services in different departments because the cost center
number changes. Therefore, the OR (cost center 433) could very well have
an ortho pack using item number 1234 (433-1234) or Radiology (cost
center 555) could have a knee X ray with the 1234 number scheme.
Each new item or service provided by a cost center
goes through a review process that looks at the item, determines if it
requires a CPT code (not every items does), uses a multiplier to set the
patient’s charge based on a cost formula and gives it the item number.
It also is mapped to a revenue code. The revenue code determines where
it will be listed on the UB92. This entire process usually involves
staff from Patient Accounts, Medical Records, the requesting department,
Info Systems and Finance, although your hospital may have a variation
of this. Find out how this process works at your own facility.
The majority of requests for additions or deletions
coincide with the new CPT and HCPCS codes that become effective January 1
of each year. HCFA almost always allows a 90-day grace period until
April 1 of that year to phase out newly deleted codes and the
implementation of any new codes. However, with the start of OPPS we now
have new pass-through items quarterly.
Each cost center is given a revenue usage report on a
monthly basis that shows which items from that cost center were billed
in the previous month. This is a tremendous tool for auditing the
services provided by your staff and in determining staffing needs. It is
often used as an inventory control for supply items. Some reports may
even show the breakdown of usage by financial class (Medicare, Medicaid,
BCBS, Self-Pay and HMO) and also by inpatient or outpatient use. This
report is especially useful when a chargemaster review is taking place
as it helps to weed out items no longer billed by a department. Other
questions to ask are:
• Does the CDM really have every billable
item or service in it? As a test, take the list of available CAT Scan
CPT codes and see how it compares to the ones offered by your CT
department. (Hint: New CPT coded procedures may be missing from the list
or it could also be that those procedures are just not done at your
facility.)
•Do the service items map to the correct
revenue code as assigned by HCFA for OPPS? (Hint: See Program Memo A
01-50 recently issued by HCFA changing which items go with certain Rev
codes effective 1/1/02.)
•Does the CPT code assigned to a line item
match the description? (Is the line item description a three-view X ray
but the CPT code description a two-view X ray?)
•Are the Modifiers required on the appropriate line item?
•Is the price within an acceptable price
range or over the years have those yearly 5-10% price increases
drastically distorted the charge?
Items with CPT/HCPCS codes built into the CDM are
referred to as “hardcoded” whereas the items that have CPT/HCPCS
assigned by HIM are called ” softcoded”. The description for the CDM is
usually limited to 25 to 30 character spaces that can and does call for
some creative abbreviations. The thing to remember is to be consistent
with those abbreviations throughout the entire CDM. Also, when setting
up the description, try to use the common noun first, followed by the
main adjective then proper noun i.e. cath, foley Bard or cath, triple
lumen. Using this method allows you to do an alpha sort of your entire
facility CDM and every cath, triple lumen from every department using
them will fall together. The finance department can make sure the price
is the same from all areas using like items. But, be consistent if you
use that comma or else an alpha sort will repeat the sort first without
commas, then with commas and be a nightmare for anyone trying to find a
specific item.
Breaking the above rule!
With APCs, many hospitals are finding it difficult
to append the correct modifiers to repeat procedures and service.
(Helpful hint: Set the repeat lab test, EKG or chest X ray in the CDM
with the word “Repeat” listed first.)
For example, in the ED have a CDM line item for
“EKG” and another one for “REPEAT EKG” When the item is selected by the
staff it will automatically be hardcoded with the appropriate modifier
(76) that indicates to HCFA and passes through the OCE that it is a
repeat test. Review which lab tests are often repeated, such as
potassium, and do the same thing using modifier 91 in that instance.