Q: We are having a heated internal discussion regarding reporting drug infusion charges when a multi-lumen catheter is being used. Nursing wants to charge for both lumens as if they were a separate line because they are hanging different medications and fluids through each one. When we tried this on a claim, the edits were either saying we needed to append a modifier for one of the initial hours of service or we hit the medically unlikely edit because of too many units. How is this supposed to be reported?
Q: I have a follow-up question to last week’s answer about lab payments. We should receive payment for a lab-only claim because of the new Q4 status indicator. However, we noticed that sometimes we do and sometimes we don’t. The difference seems to be when we report a venipuncture and when we report the blood being drawn from a ventricular assist device (VAD). When the venipuncture is reported, we get paid for all line items. When the blood draw is from a VAD, we don’t get paid for the lab work. Is this correct?
Q: If we're not using condition code W2 but we're billing on the type of bill (TOB) 121 after we received a denial, are we paid less than if the W2 would have been used?
Q: I was at a conference last week and while we were on a break, I heard someone say that we don’t have to use modifier -L1 (separately payable laboratory test) to get paid for lab work from Medicare. Is that true?
Q: Does the concurrence of the attending physician, that is required for condition code 44, need to be recorded by the attending physician, or can another practitioner write the concurrence
Submit your HIPAA questions to Associate Editor Nicole Votta at nvotta@hcpro.com and we will work with our experts to provide you with the information you need.
Q: Our front desk receptionist has asked the following question regarding residents who are admitted to our long-term care facility. If someone calls the front desk asking for information on a resident, such as "Is (resident) in your facility?" or "What is their room number?", would this information be considered PHI?
A: The answer is not straightforward when it comes to long-term care. It all depends on the care setting. If care is provided in an assisted living facility and the assisted living facility does not provide healthcare services, such as nursing care related to treatment or a clinic on-site, the information is not PHI. On the other hand, if the facility is a skilled nursing facility (SNF) and is providing what HIPAA defines as healthcare, it would be considered PHI. That doesn't mean the receptionist cannot share the information about whether a resident is at the facility or the resident's room number. Similar to a hospital, a long-term care facility could maintain a facilities directory. Unless the resident has specifically requested he or she not be included in the facility directory, you can share whether a resident is at the facility and where the resident is located in the facility. Providing more information would be prohibited. Review the long-term care regulations in the state in your state.
Editor’s note: Chris Apgar, CISSP, president of Apgar and Associates in Portland, Oregon, answered this question. This information does not constitute legal advice. Consult legal counsel for answers to specific privacy and security questions.
Q: When you refer to a laptop being encrypted for security reasons, is that the same as password protected? We have a number of employees with laptops who transport them from work to home and are concerned about a breach if a laptop is stolen.
Q: The company I work for has long debated what to do about medical records that are sent out on CDs. We concluded that since paper records could not be encrypted, we shouldn't have to worry about encrypting the CDs.
Q: Is it permissible to write down a patient's pending exams (e.g., MRI, ultrasound) on the patient boards located by the patient's bed in his or her room even if that patient has a roommate?
