Presentation is loading. Please wait.

Presentation is loading. Please wait.

Review Of New CPT Codes Affecting BMT Services Presented by: James L. Gajewski, M.D.

Similar presentations


Presentation on theme: "Review Of New CPT Codes Affecting BMT Services Presented by: James L. Gajewski, M.D."— Presentation transcript:

1 Review Of New CPT Codes Affecting BMT Services Presented by: James L. Gajewski, M.D.

2 Disclaimer: Please note that the opinions expressed in this presentation are those of the presenter and, as such, are intended as guidance only. As always, final interpreta- tion of the requirements of any code, including the acceptability of billing and documentation practices, rests in the domain of the private payer or authorities of the Centers for Medicare and Medicaid Services.

3 Overview Background Background Review new codes and CMS issues Review new codes and CMS issues Critical care E&M issues Critical care E&M issues Future concerns Future concerns

4 Background

5 Abbreviations CPT = Current Procedural Terminology CPT = Current Procedural Terminology RVU = Relative Value Units RVU = Relative Value Units HCPCS = Healthcare Common Procedure Coding System HCPCS = Healthcare Common Procedure Coding System

6 Committees CPT Editorial Panel CPT Editorial Panel RVU-RBRVS Update Committee (RUC) RVU-RBRVS Update Committee (RUC) Outpatient Practice Expense – Practice Expense Allocation Committee (PEAC) Outpatient Practice Expense – Practice Expense Allocation Committee (PEAC)

7 Coalition To Address Coding Deficiencies Sponsor: American Society of Hematology Sponsor: American Society of Hematology Co-Sponsors: Co-Sponsors: –American Society for Blood and Marrow Transplantation –American Association of Blood Banks –International Society of Cellular Therapy –The National Marrow Donor Program –American Society of Clinical Oncologists –American Red Cross –Exempt Cancer Centers Committee –Foundation for Cellular Therapies

8 New Billing Regulations One price per CPT code per patient bill

9 Old Codes Are Inadequate Apheresis Apheresis Apheresis Apheresis Plasma Pheresis Plasma Pheresis Cell ProcessingT- and B-cell Removal 86915; Cross-reference to and for cryopreservation and thawing Cell ProcessingT- and B-cell Removal 86915; Cross-reference to and for cryopreservation and thawing

10 CPT editorial committee has been trying to enhance “granularity” of CPT CPT editorial committee has been trying to enhance “granularity” of CPT Most patient bills need either HCPCS Level I better known as CPT codes Most patient bills need either HCPCS Level I better known as CPT codesOR HCPCS Level II codes attached to services for electronic billing of services HCPCS Level II codes attached to services for electronic billing of services

11 Review Of New Codes Rationale behind request Rationale behind request Facility related expenses Facility related expenses Physician professional component Physician professional component Documentation necessities Documentation necessities

12 Apheresis Therapeutic apheresis: Therapeutic apheresis: –36511 For white blood cells –36512 For red blood cells –36513For platelets –36514 For plasma pheresis –36515 With extracorporeal immunoadsorption and plasma reinfusion –36516 With extracorporeal selective adsorption or selective filtration and plasma reinfusion

13 Apheresis Rationale Different costs of disposables for different procedures Different costs of disposables for different procedures Different types of personnel using procedures that are commonly performed on emergent basis Different types of personnel using procedures that are commonly performed on emergent basis Different level of physician involvement for different procedures Different level of physician involvement for different procedures

14 Apheresis Facility Related Expenses All apheresis codes are billed as facility based All apheresis codes are billed as facility based Each procedure has separately priced disposables Each procedure has separately priced disposables Each code has the appropriate technical component to assure appropriate billing Each code has the appropriate technical component to assure appropriate billing –e.g. time for performing a white blood cell or plasma exchange may be greater than a red blood cell or platelet exchange

15 Apheresis Facility Related Expenses For governmental payers, these procedures can only be billed from hospital based inpatient or outpatient facilities For governmental payers, these procedures can only be billed from hospital based inpatient or outpatient facilities Project for future is PEAC survey for these services so that free standing facilities can bill governmental payers Project for future is PEAC survey for these services so that free standing facilities can bill governmental payers

16 Apheresis Physician Professional Component Physician work effort surveys were done but RUC did not approve of the surveys Physician work effort surveys were done but RUC did not approve of the surveys Each apheresis procedure has an RVU of 1.74 Each apheresis procedure has an RVU of 1.74 The RVU for may be decreased to 1.22 in 2004 The RVU for may be decreased to 1.22 in 2004

17 Apheresis Professional Billing Criteria 1. Procedural professional fee does not require physician to do procedure, but requires physician to examine patient during procedure and demonstrate active supervision of procedure. 2. Physician must be available. Available means within hospital during entire procedure. This does not mean the physician must remain in pheresis unit.

18 Apheresis Professional Billing Criteria 3. Evaluation of patients for apheresis is billable separately as long as it is done on a different day. This is billed on consult H&P. 4. Post-procedure follow-up is also billable separately as long as it is done on a different day, following E&M service. 5. For inpatients, different physicians from same specialty may bill service on the same day. Hematologists follow acute leukemia on inpatients and different hematologists perform apheresis procedures.

19 Billing for apheresis services would be easier if apheresis was recognized as a unique specialty!

20 Donor Search and Transplant Product Acquisition 38204Management of recipient hematopoietic progenitor cell donor search and cell acquisition 38204Management of recipient hematopoietic progenitor cell donor search and cell acquisition

21 Donor Search and Transplant Product Acquisition – Physician Professional Component For physician supervision of donor search coordinators identifying an unrelated donor and communicating with donor center medical directors and the harvesting physicians. This code is also to be used for cord blood searches. Patient contact is not necessary for this code to be billed. For physician supervision of donor search coordinators identifying an unrelated donor and communicating with donor center medical directors and the harvesting physicians. This code is also to be used for cord blood searches. Patient contact is not necessary for this code to be billed.

22 Donor Search and Transplant Product Acquisition – Facility Related Expenses This donor search CPT code may not be used for NMDP/Cord Blood Registry donor services on product acquisition. This donor search CPT code may not be used for NMDP/Cord Blood Registry donor services on product acquisition. On patient bills, these services should either have no CPT attached or a generic CPT code such as On patient bills, these services should either have no CPT attached or a generic CPT code such as Future task is to create HCPCS Level II codes for these services. Future task is to create HCPCS Level II codes for these services.

23 Donor Search and Transplant Product Acquisition – Facility Related Expenses The donor search code will usually be billed once. This may be billed for successful and unsuccessful searches. The donor search code will usually be billed once. This may be billed for successful and unsuccessful searches. If a search goes to BMT, the BMT fails and a new search is done for a new donor, this code may be billed twice. If a search goes to BMT, the BMT fails and a new search is done for a new donor, this code may be billed twice. If a DLI or boost from the same donor is used, then this code may not be billed twice. If a DLI or boost from the same donor is used, then this code may not be billed twice.

24 Donor Search and Transplant Product Acquisition – Medicare chose not to recognize this code. Medicare felt the service should be valued under infusion CPT Medicare chose not to recognize this code. Medicare felt the service should be valued under infusion CPT Appeal is underway. Appeal is underway.

25 Stem Cell Collection Blood derived hematopoietic progenitor cell harvest for transplantation; allogeneic Blood derived hematopoietic progenitor cell harvest for transplantation; allogeneic Blood derived hematopoietic progenitor cell harvest for transplantation; autologous Blood derived hematopoietic progenitor cell harvest for transplantation; autologous

26 Stem Cell Collection – & Rationale The old codes were split due to expenses for donor evaluation The old codes were split due to expenses for donor evaluation

27 Stem Cell Collection – & Facility Related Expenses Both codes cover the collection services for one day’s collection. Multiple day’s services require multiple uses of this code.

28 Stem Cell Collection – & Facility Related Expenses For governmental payers, i.e. Medicare or Medicaid, these services are facility based. For governmental payers, i.e. Medicare or Medicaid, these services are facility based. They can only be billed from hospital based inpatient or outpatient collection facilities. This does not apply to non-governmental payers. They can only be billed from hospital based inpatient or outpatient collection facilities. This does not apply to non-governmental payers. If we try to make these codes not-facility based, the issue is whether nurse time can be attached to practice expense or must be allocated to professional fee. This needs to be better understood before doing a PEAC survey If we try to make these codes not-facility based, the issue is whether nurse time can be attached to practice expense or must be allocated to professional fee. This needs to be better understood before doing a PEAC survey

29 Stem Cell Collection – & Suggested Facility Related Expenses The pricing of the service may include: The pricing of the service may include: Nurse/technician time, machine disposables, machine depreciation, space utilized and all costs associated with meeting regulatory requirements.

30 Stem Cell Collection – & Physician Professional Component Physicians may bill for this procedure even if not doing the procedure. RVU valuation was for physician supervision of nurse/ technician performing the procedure. To bill, the physician must document exams during procedures and supervision of staff for a particular patient. Physician must remain within hospital for entirety of procedure and be immediately available. The physician does not need to be in the apheresis unit for entirety of procedure. Physicians may bill for this procedure even if not doing the procedure. RVU valuation was for physician supervision of nurse/ technician performing the procedure. To bill, the physician must document exams during procedures and supervision of staff for a particular patient. Physician must remain within hospital for entirety of procedure and be immediately available. The physician does not need to be in the apheresis unit for entirety of procedure. This is a per-day physician charge for management of collection. For multiple day collections, these codes may be be billed on multiple days. This is a per-day physician charge for management of collection. For multiple day collections, these codes may be be billed on multiple days.

31 Allogeneic Stem Cell Collection – Physician Professional Component Allogeneic donor assessment for apheresis should be new patient – not consult H&P (there is not referring physician). Allogeneic donor assessment for apheresis should be new patient – not consult H&P (there is not referring physician). Follow-up after care on a different day may use follow-up E&M codes. Follow-up after care on a different day may use follow-up E&M codes.

32 Autologous Stem Cell Collection – Physician Professional Component Autologous pre-stem cell collection may be billed as a consult H&P if the physician doing apheresis is different from the physician managing the cancer care. This can be a “within specialty” consult; however, this consult cannot be done on the day of collection. Wording of consult is important-or it will be a referral-transfer of care. Autologous pre-stem cell collection may be billed as a consult H&P if the physician doing apheresis is different from the physician managing the cancer care. This can be a “within specialty” consult; however, this consult cannot be done on the day of collection. Wording of consult is important-or it will be a referral-transfer of care. Autologous post-proceeding assessment is billable by E&M codes for follow-up as long as by different physicians doing routine cancer care. This cannot be billed on the day of collection. Autologous post-proceeding assessment is billable by E&M codes for follow-up as long as by different physicians doing routine cancer care. This cannot be billed on the day of collection.

33 Cell Processing

34 Cell Processing Rationale Allow granularity for cell processing so that we do not utilize the old for red blood cell depletion Allow granularity for cell processing so that we do not utilize the old for red blood cell depletion Codes moved to join other BMT related codes in CPT manual Codes moved to join other BMT related codes in CPT manual Removed reference to and which were designed for laboratory diagnostic procedures not therapeutic transplant services Removed reference to and which were designed for laboratory diagnostic procedures not therapeutic transplant services

35 Cell Processing Codes Rationale CPT would only give codes to procedural processes that are accepted CPT would only give codes to procedural processes that are accepted T-cell depletion and tumor purging have codes but not CD34 selection T-cell depletion and tumor purging have codes but not CD34 selection Stem cell expansion still in research and we cannot set code for this service Stem cell expansion still in research and we cannot set code for this service

36 Cell Processing Generic Facility Pricing Issues These are per day codes These are per day codes Markets sets prices, but in assessing cost to determine institutional pricing consider including: Markets sets prices, but in assessing cost to determine institutional pricing consider including: –Technician time, supplies, machine use, machine depreciation, space costs, malpractice risk, quality assurance testing of an individual product, overhead Pricing may include amortization of GMP laboratory construction cost but must be amortized over 10 years Pricing may include amortization of GMP laboratory construction cost but must be amortized over 10 years RVU-RBRVS Committee established temporary RVU’s for all of these codes, but CMS chose not to recognize these rvu’s RVU-RBRVS Committee established temporary RVU’s for all of these codes, but CMS chose not to recognize these rvu’s

37 Cell Processing Physician Work Effort Includes: Includes: –Review of data important for cell processing decisions –Supervision of technicians performing an individual patient’s cell processing –Review and interpretation of quality assurance procedures for an individual patient’s cells being processed, including flow cytometry –Report on product adequacy and ability of cellular product to meet expectations –Time for report preparation and review of cell processing –Malpractice risk –Psychological stress

38 Cell Processing Transplant preparation of hematopoietic progenitor cells; cryopreservation and storage

39 Cell Processing – Suggested Facility Related Expenses For cryopreservation and storage of bone marrow or peripheral blood progenitor cells.For cryopreservation and storage of bone marrow or peripheral blood progenitor cells. Facility fees include tech time, laboratory supplies, machinery, machinery depreciation, and space costs.Facility fees include tech time, laboratory supplies, machinery, machinery depreciation, and space costs. If mononuclear cell processing was done prior toIf mononuclear cell processing was done prior to cryopreservation, it should be billed separately. Cryopreservation charge should include all qualityCryopreservation charge should include all quality assurance testing. After 2004, this code will include billing for all flowAfter 2004, this code will include billing for all flow cytometry tests used for quality assurance testing.

40 Cell Processing – Physician Professional Component Planning for cryopreservation Planning for cryopreservation –How many stem cells or T-cells will be stored to meet needs of transplant? –What are anticipated issues? »Donor-recipient HLA/ABO/infectious disease serology, recipient/donor size disparity –What is RBC contamination of product? –Which quality assurance procedures will be performed? »CD34, CD3 tests »Microbiology testing –Technician supervision –Review of freezer curves –Report generation to review adequacy of cryopreserved product and the product’s ability to meet specifications

41 Cell Processing Transplant preparation of hematopoietic progenitor cells; thawing of a previously cryopreserved progenitor cell harvest

42 Cell Processing – Suggested Facility Related Expenses For thawing of harvest on the day of infusionFor thawing of harvest on the day of infusion Includes all equipment, equipment depreciation, space costs, and technician time used in thawing processIncludes all equipment, equipment depreciation, space costs, and technician time used in thawing process Post thaw viability testingPost thaw viability testing

43 Cell Processing – Physician Professional Component Includes: Includes: –Review of patient/donor data, freezer curves, adequacy of cryopreserved product –Supervision of thawing, quality assurance testing of pre- and post-thaw product i.e. viability testing flow cytometry (obviously this does not hold up thaw) –Need for special procedures for thawing processes i.e. need for wash; concerns for incompatible RBC contamination –Report on product adequacy and ability to meet specifications –Preparation time for a thaw report –After 2004, flow cytometry will not be billed separately

44 Cell Processing Transplant preparation of hematopoietic progenitor cells; washing of a previously cryopreserved progenitor cell harvest

45 Cell Processing – Rationale and Suggested Facility Fee Issues For 2003, this is only for thawed cells requiring a wash to remove DMSO For 2003, this is only for thawed cells requiring a wash to remove DMSO Facility fee should include technician time, machinery, supplies and machinery depreciation Facility fee should include technician time, machinery, supplies and machinery depreciation Post-wash viability testing Post-wash viability testing In 2004, this code will be redesigned for thawing without wash and thawing with wash In 2004, this code will be redesigned for thawing without wash and thawing with wash

46 Cell Processing – Physician Professional Component Technician supervision of process Technician supervision of process Quality assurance of product after wash Quality assurance of product after wash Report generation to review adequacy of product and product’s ability to meet transplant specifications Report generation to review adequacy of product and product’s ability to meet transplant specifications

47 Cell Processing T-Cell Depletion

48 Cell Processing – Suggested Facility Related Expenses Facility fees may include machinery, machinery depreciation, technician time, supplies, space costs, and quality assurance testing Facility fees may include machinery, machinery depreciation, technician time, supplies, space costs, and quality assurance testing If cryopreservation is needed, it may be billed separately If cryopreservation is needed, it may be billed separately If mononuclear cell separation not usually done prior, then may be billed separately If mononuclear cell separation not usually done prior, then may be billed separately Tests to evaluate efficacy of T-cell depletion Tests to evaluate efficacy of T-cell depletion Tests to evaluate viability after T-cell depletion Tests to evaluate viability after T-cell depletion In 2004, will include flow cytometry testing, pre and post In 2004, will include flow cytometry testing, pre and post

49 Cell Processing – Physician Professional Component Assess donor/recipient suitability for T-cell depletion Assess donor/recipient suitability for T-cell depletion Assess HLA typing, donor/recipient size disparity Assess HLA typing, donor/recipient size disparity Assess quality of product coming to lab for T-cell depletion, cell number, CD34 count, CD3 counts Assess quality of product coming to lab for T-cell depletion, cell number, CD34 count, CD3 counts Supervision of technician performing processing Supervision of technician performing processing Assessment of efficacy of T-cell depletion Assessment of efficacy of T-cell depletion Review and interpretation of quality assurance testing Review and interpretation of quality assurance testing Report preparation on quality of product to meet specifications Report preparation on quality of product to meet specifications

50 Cell Processing Tumor cell depletion

51 Cell Processing – Suggested Facility Related Expenses For autologous transplantation For autologous transplantation Facility fees may include machinery, machinery depreciation, technician time, supplies, space costs and quality assurance testing Facility fees may include machinery, machinery depreciation, technician time, supplies, space costs and quality assurance testing Testing to document efficacy of tumor purging Testing to document efficacy of tumor purging Testing to document post-tumor purging cell viability Testing to document post-tumor purging cell viability Cryopreservation is always done and therefore should not be billed separately Cryopreservation is always done and therefore should not be billed separately If mononuclear cell separation is always done, it should be included in pricing; if not, do not include in pricing If mononuclear cell separation is always done, it should be included in pricing; if not, do not include in pricing After 2004, flow cytometry assessment must be included in pricing and cannot be billed separately After 2004, flow cytometry assessment must be included in pricing and cannot be billed separately

52 Cell Processing – Physician Professional Component Assessment of need for tumor purging Assessment of need for tumor purging Assessment of quality of product for tumor purging Assessment of quality of product for tumor purging Supervision of technician performing tumor purging Supervision of technician performing tumor purging Assessment of efficacy of tumor purging Assessment of efficacy of tumor purging QA testing and review QA testing and review Report preparation on quality of product and that product meets specifications requested Report preparation on quality of product and that product meets specifications requested

53 Cell Processing Red blood cell removal

54 Cell Processing – Suggested Facility Related Expenses For a fresh allogeneic harvest; removal of RBC’s in preparation for transplant For a fresh allogeneic harvest; removal of RBC’s in preparation for transplant Facility fees may include tech time, supplies, machinery and red cell depletion for a major ABO incompatible bone marrow harvest Facility fees may include tech time, supplies, machinery and red cell depletion for a major ABO incompatible bone marrow harvest Testing of efficacy of RBC removal Testing of efficacy of RBC removal Testing of viability of progenitor cells after RBC removal Testing of viability of progenitor cells after RBC removal In 2004, will include price for flow cytometry testing for quality assurance In 2004, will include price for flow cytometry testing for quality assurance

55 Cell Processing – Physician Professional Component Review of ABO typing prior to harvest Review of ABO typing prior to harvest Supervision of the process Supervision of the process Review of quality assurance testing Review of quality assurance testing Report preparation that product meets or does not meet specifications Report preparation that product meets or does not meet specifications

56 Cell Processing Platelet depletion

57 Cell Processing – Rationale For peripheral blood progenitor cell harvest with a platelet soft spin For peripheral blood progenitor cell harvest with a platelet soft spin No RVU’s are assigned to this code because no physician assessment is done for quality of platelet addback given to any donor with low platelet counts No RVU’s are assigned to this code because no physician assessment is done for quality of platelet addback given to any donor with low platelet counts

58 Cell Processing Plasma/volume depletion

59 Cell Processing – Suggested Facility Related Expenses For a fresh bone marrow harvest and for plasma removal For a fresh bone marrow harvest and for plasma removal Facility fees may include technician time, supplies, and machinery Facility fees may include technician time, supplies, and machinery For viability testing after plasma removal For viability testing after plasma removal For 2004, will include flow cytometry testing for quality assurance of product For 2004, will include flow cytometry testing for quality assurance of product

60 Cell Processing – Physician Professional Component Review of donor/recipient size and ABO blood types Review of donor/recipient size and ABO blood types Quality assurance of product Quality assurance of product Supervision of cell processing Supervision of cell processing Report generation of product meets or does not meet specifications Report generation of product meets or does not meet specifications

61 Cell Processing Cell concentration of plasma, mononuclear, or buffy coat layer

62 Cell Processing – Rationale For mononuclear cell preparation for major/minor ABO incompatibility on a fresh bone marrow harvest or for further cell processing procedures For mononuclear cell preparation for major/minor ABO incompatibility on a fresh bone marrow harvest or for further cell processing procedures For occasional mononuclear cell separation for further manipulation, if this is not routinely done for additional procedures then mononuclear cell preparation may be billed separately For occasional mononuclear cell separation for further manipulation, if this is not routinely done for additional procedures then mononuclear cell preparation may be billed separately

63 Cell Processing – Physician Professional Component Review of donor/recipient ABO incompatibility Review of donor/recipient ABO incompatibility Supervision of cell processing Supervision of cell processing Quality assurance testing Quality assurance testing Report preparation Report preparation

64 38242 Donor Lymphocyte Infusion This code is to administer a post allogeneic donor lymphocyte infusion to treat relapse of malignancy or infection after allogeneic bmt. This code is to administer a post allogeneic donor lymphocyte infusion to treat relapse of malignancy or infection after allogeneic bmt. For boost of progenitor cells to treat pancytopenia still use 38240, the allogeneic transplant infusion code. For boost of progenitor cells to treat pancytopenia still use 38240, the allogeneic transplant infusion code.

65 CMS Issues

66 The Unprocessed Stem Cells CPT editorial board refused our request for a code for generic quality assurance testing CPT editorial board refused our request for a code for generic quality assurance testing Only option is for those patients to continue to bill those services under 38240, 38241, and Only option is for those patients to continue to bill those services under 38240, 38241, and 38242

67 CMS Issues CMS did not approve these cell processing codes and the code for unrelated donor search and organ acquisition and 38204s CMS did not approve these cell processing codes and the code for unrelated donor search and organ acquisition and 38204s These codes can be used to bill these services to non-governmental payers These codes can be used to bill these services to non-governmental payers CMS has always had difficulty paying for organ acquisition costs CMS has always had difficulty paying for organ acquisition costs CMS moved these codes to to G- code section of HCPCS Level II and will pay for cryopreservation and storage at rate for and CMS moved these codes to to G- code section of HCPCS Level II and will pay for cryopreservation and storage at rate for and 88241

68 CMS Issues With the new codes we probably are better off with the non-governmental payers With the new codes we probably are better off with the non-governmental payers With CMS, we are no worse off With CMS, we are no worse off Work on these codes brought increased scrutiny to all apheresis and BMT related cost Work on these codes brought increased scrutiny to all apheresis and BMT related cost These codes were presented as facility based. To do practice expensing would require a survey of how may pipettes, 4x4’s, we all use for every procedure These codes were presented as facility based. To do practice expensing would require a survey of how may pipettes, 4x4’s, we all use for every procedure

69 Critical Care E&M Issues

70 Critical Care Critical care can billed for service rendered for patient not in MICU Critical care can billed for service rendered for patient not in MICU Advantage of critical care for E&M is that it is a time based code. Advantage of critical care for E&M is that it is a time based code. Critical care pays more RVU’s than most complex inpatient E&M code (4 vs. 1.51, respectively) Critical care pays more RVU’s than most complex inpatient E&M code (4 vs. 1.51, respectively)

71 Critical Care Critical care is direct delivery by a physician of medical care for a critically ill or critically injured patient. Critical care is direct delivery by a physician of medical care for a critically ill or critically injured patient. A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient’s condition. A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient’s condition. CPT 2003, Professional Edition

72 Critical Care Critical care involves high complexity decision making to assess, manipulate, and support vital system function(s) to treat single or multiple vital organ system failure and/or prevent further life threatening, deterioration of the patient’s condition. Critical care involves high complexity decision making to assess, manipulate, and support vital system function(s) to treat single or multiple vital organ system failure and/or prevent further life threatening, deterioration of the patient’s condition. CPT 2003, Professional Edition CPT 2003, Professional Edition

73 Future Concerns

74 No one is totally satisfied with the results No one is totally satisfied with the results Billing these new codes will require more time and effort Billing these new codes will require more time and effort Billing is moving to electronic transmittal of data. Each item in bill needs either a CPT code or HSPCS level II code Billing is moving to electronic transmittal of data. Each item in bill needs either a CPT code or HSPCS level II code Billing these codes is important in case rate payments because underlying charges determine how case rate payment is allocated within institutions. Even if bill is paid as case rate, third party payers are to receive itemized bill. Billing these codes is important in case rate payments because underlying charges determine how case rate payment is allocated within institutions. Even if bill is paid as case rate, third party payers are to receive itemized bill.

75 Future Concerns The January 26, 2003, edition of the New York Time’s indicated we and our hospitals cannot expect to charge as much as we are to pharmaceuticals. We will need these services with legitimate costs adequately to justify current case rates. The January 26, 2003, edition of the New York Time’s indicated we and our hospitals cannot expect to charge as much as we are to pharmaceuticals. We will need these services with legitimate costs adequately to justify current case rates.

76 ASBMT and the bmt community owes a great debt for the service of Samuel Silver, M.D., Ph.D. and ASH staff Their ongoing labors for financial issues have not received the national accolades they deserve


Download ppt "Review Of New CPT Codes Affecting BMT Services Presented by: James L. Gajewski, M.D."

Similar presentations


Ads by Google