News

Q: I have a question regarding which place of service (POS) code I should use for an orthopedic doctor who did a consultation on a patient that came through the ED. The patient has a spiral fracture of the humerus. The electronic record documents that the patient was admitted to the medical unit on January 31 but was a “boarder” in the ED until February 2, waiting on a room to be available. The orthopedic doctor saw the patient on February 1. The patient did finally receive a room assignment on February 2. In this scenario would I use POS 22 (outpatient hospital) or 23 (ED)? This patient has Medicare.

This week’s updates include new waived tests; guidance to surveyors in conducting exit conferences; and more!

Q: What are therapeutic services?

CMS released a series of special edition articles applicable to chiropractic services on March 16. Medicare has a very limited coverage benefit for chiropractic services. This article will explain when treatment is covered and how to properly document medical necessity.

Q: Did something change with the observation services Composite APC in 2016? The director of patient financial services says we no longer receive payment for it.

This week’s updates include implementation of the award for Jurisdiction A DME MAC workload; April 2016 Integrated Outpatient Code Editor (I/OCE) Specifications Version 17.1; and more!

The healthcare industry got a five-year break from annual code updates for ICD codes as preparations for ICD-10 implementation took place, but the updates will be back this year and bigger than ever. 

CMS’ proposed two-phase test model for Part B prescription drug payments—which would lower the percentage paid based on average sales price but add a flat fee and include value-based purchasing tools—has seen a mixed reaction from the industry.

The Social Security Act allows CAHs and other small rural hospitals to enter into “swing bed” agreements with CMS. Under these arrangements, in addition to providing acute inpatient services, such hospitals are permitted to provide extended care services that would normally be furnished in a skilled nursing facility (SNF). When provided under a swing bed arrangement, SNF extended care services are referred to as “swing bed” services. In a swing bed hospital, an inpatient bed may actually swing from one level of care to another (e.g., acute to swing or swing to acute), depending upon a particular patient’s need.

Q: Our radiology department is requesting that we add a new modifier to their charge description master (CDM), modifier –CT (computed tomography [CT] services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association [NEMA] XR-29-2013 standard). They want this added to the CT scan line items, but they are not sure if it is for all of the items or only certain ones. Can you provide more information that might help us know how to proceed?