Q: Are disposable instrumentation tools, those typically used in endoscopic or cardiac procedures, considered integral to the procedure or are they separately chargeable?
Q: I'm told, although I'm not convinced, that our payment for Keytruda is denied by Anthem when we use Z51.11 (encounter for antineoplastic chemotherapy) first followed by the code for cancer, i.e. C34.12 (malignant neoplasm of upper lobe, left bronchus or lung). I reviewed the coding guidelines again and that is our instruction. Does anyone have experience with this issue?
Q: Our new EHR system was built using logic for therapy charging based on both the AMA and CMS eight-minute rules. Charges will generate differently based on the payer. How do others implement the eight-minute rules? How do you think using two charging methodologies in this world of price transparency will look?
Q: We are in the middle of changing the hospital methodology for charging cardiac cath procedures within Epic CUPID. What is your hospital’s workflow for charging cardiac cath procedures?
Q: My team is asking me if we should combine pre-admission testing (PAT) visits with the surgery bill. I'm thinking no because some of the PAT services are not routine for the surgery. However, isn't there a rule about services that can't be billed separately prior to surgery?
Q: I was on a conference call with the CDM coordinators within my health system and we got involved in a lively discussion. If there's no medical necessity for observation, what do you do with charges? Our departments get productivity based on the charges posted. We all agreed that the observation charges shouldn't be billed to the insurance but had different opinions on how it should be handled.
Q: My team has asked me to look into charging for RF generator usage, which is about $850.00 per procedure. Is this something we can or should capture in the chargemaster?
