Reader Question: Acuity Systems

Question: We now have an acuity scoring system the nurses tally to determine the facility level billed. This includes points for procedures typically performed by nurses, i.e., injections, IV starts, Foleys, etc. Will APCs require us to unbundle our acuity system and bill separately for these procedures performed by nurses? If so, would you advise billing this way for all payer types? Could we enter procedure codes with a $0.00 charge and keep the same acuity system for all payers?

Danusia Lorentz
Mercy Medical Center, Durango, Colo.

Answer: You will be required to identify each procedure performed in hospital outpatient departments by assigning a code for the service. When a significant and separate evaluation and management (E/M) service is provided at the time a procedure also is performed, you will bill an E/M code (nursing acuity/facility level) with the -25 modifier.

Prior to Jan. 1, 2001, you will not be required to assign a separate charge for each procedure. You may total the charge for all procedures on the same line as any one procedure and bill the others with a 0 in the charge field.

The instructions from HCFA seem to reference the procedures separately from the acuity level, which might indicate that one charge would be billed for the acuity level and one bundled charge for any and all procedures. After Jan. 1, you will be required to assign a separate charge to each billed procedure.

With regard to non-Medicare payers, some payers may pay better under their current global charge system, so you will need to contact each of your major payers to determine if the APC billing system will improve your revenue.


- Published on 2000-09-01