Status Indicators Can Eliminate Performing Inpatient Procedures on an Outpatient Basis

If you are working with APCs, you need to know what status indicators are, what each indicator means, and how this can affect you, because this is valuable information that can be used in several ways.

Status indicators can be used to do internal reports, which is an important way to track procedures. For example, are you coding enough C codes to cover your supplies? The status indicators G, H and J can be used to find out.

If you watch your status indicators and you aren't seeing many G, H or J indicators, you are missing out on billing for supplies (C codes) because G, H and J status indicators often accompany C codes.

Also, status indicators can help you make sure you catch inpatient procedures before they are done on an outpatient basis. If these inpatient procedures are missed, you lose the opportunity to get reimbursed for them.

In the Sept. 8, 1998, proposed rule in the Federal Register, HCFA proposed a payment status indicator for every code in the HCPCS manual to identify how the service or procedure described by the code would be paid under the hospital outpatient prospective payment system (OPPS). In the April 7, 2000, Federal Register, this proposal became a reality and payment status indicators were implemented as part of OPPS.

But what are status indicators, and what effect do they have on you? Medicare assigns status indicators to every code. There are 14 status indicators (for the list and description, please see the next article).

You need to be aware of what those indicators mean and how they impact your facility, explains Jan Weins, RHIA, director of medical records at East Texas Medical Center in Athens. You especially need to know which codes are inpatient only.

Inpatient: Status Indicator C

Knowing which codes have a status indicator of C can help prevent a facility from performing an inpatient procedure on an outpatient basis. Weve already run into it, Weins explains. If it is a CPT code thats designated as inpatient only you are not going to get paid for that if you do that as an outpatient. You need to be proactive with those and know you cant use it, or else you are doing the procedure for free, because once the claims are submitted you cant go back and fix them.

For example, a Denver shunt (49425, insertion of peritoneal-venous shunt) was performed twice at Weins facility, and they lost reimbursement on both procedures.

The physician put the patient in day-surgery status and kept him overnight as a day surgery, Weins says. Once we code it, we see it is an inpatient-only procedure, but by that point it is too late.

Karla [...]

- Published on 2001-01-01