BILLING BASICS: Steer Clear of the Top-5 Chargemaster Pitfalls

Tackle trouble at its root to lock in reimbursement

Whether your facility has just completed an annual chargemaster review or isn't due to have one for several months, you can ensure a smoother process, better compliance, and more reimbursement by knowing the most widespread CDM difficulties - and knowing how to deal with them.
1. Right Code, Wrong Place
Every coder has that frustrating handful of codes she always mixes up, but when you factor the charge description master (CDM) into the mix, a few incorrect codes can quickly add up to big bucks - and possibly major compliance errors.
For example, revenue codes 636 (Drugs that require detailed coding) and 250 (General pharmacy) both accompany drug codes, but because coders have little to no official guidance about when to choose one or the other, they often use these codes inappropriately on claims, says Sandra Giangreco, CPC, CPC-H, RHIT-eligible, chargemaster coordinator/liaison at Bay Area Medical Center in Marinette, Wis.
Tip: For HCPCS codes with status indicator K or G, use revenue code 636. For all other drugs, use revenue code 250, Giangreco says. However, some fiscal intermediaries, such as UGS Medicare (which serves facilities nationwide), want to see revenue code 636 on all HCPCS-coded pharmaceuticals - so check with payers about their preferences, says Sarah L. Goodman, MBA, CPC-H, CCP, president of SLG Inc. in Raleigh, N.C.
Another common problem is incorrectly billing for outpatient services provided in multiple locations. If your hospital provides services for the same patient in several different parts of the facility, make sure you note where each was performed and attach it to the appropriate revenue code for that department, such as 762 for services performed in the observation room or 450 for services performed in the emergency department.
2. Linking Codes Inappropriately
You have your eyes peeled for links between incorrect (or medically unnecessary) diagnoses and procedures, but keep in mind that some situations call for you to link certain HCPCS codes with CPT codes.
For instance, if you report a C code, you need to report it with the relevant procedure, Giangreco says. Code C2620 (Pacemaker, single chamber, non-rate-responsive [implantable]), for example, must accompany one of the following codes for pacemaker insertion: 33206 (Insertion or replacement of permanent pacemaker with transvenous electrode[s]; atrial) or 33207 (... ventricular).
This is often complicated by the fact that the health information management department would be soft-coding the pacemaker insertions, while the pacemaker device codes would derive from the CDM, Goodman says.
3. Mysterious Mistakes in Services or Supplies
Inform the CDM coordinator as soon as possible when services and supplies and their costs change, [...]

- Published on 2005-07-20