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CRIP Set 6
| Question | Answer |
|---|---|
| What does the FDA define as an implant? | A device intended to be implanted into a surgically or naturally formed cavity of the human body to continuously assist, restore, or replace the functions of an organ system or structure of the human body for 30 days or more. |
| What information must be obtained when a facility uses an implant device? | Facility name and address any ID numbers on the implant such as lots, model, serial number Patience demo info Name and demographics of the Sergeant who performed the procedure of the implant and if different The physician who is following the patient |
| What are ways in which the facility can evaluate the usage of implants and identify potential savings? | Identify the implant/ devices but the facility wants to use Work closely with physicians to consolidate to contract the vendors to achieve additional savings Work with the facility supply chain to negotiate per case payments with vendors Review all payments in order to ensure compliance is sustained savings |
| A patient in The hoarding room prior to surgery decides not to undergo scheduled procedure. However, the surgical suite is already set up along with open cereal supplies to initiate the procedure. Can the patient be billed for the supplies that were open in preparation for the surgical procedure. | Procedure is cx at any point during the eval of the procedure before the pt enters the procedure room where anesthesia is admin, then it is approp to capture for E&m serv to charge the approp level. The sx proc is considered non-billable because the pt was not taken to the surgical room. Any pre-op services, non-routine supplies, and non-self-admin pharmacy items that the pt rec prior to the cx may be billed to Medicare. As with all charges, there must be dock in the medical record to support the test. |
| Can supplies or drugs that are not actually administered to the patient be billed? This would include situations like accidentally dropping an item on the floor or opening an item and not using it | No |
| What is the revenue code on the ub04 form for reporting the technical component of anesthesia service? | 037X - anesthesia |
| Does revenue code 37x require a hcpcs code from CMS? | No, but some pairs like Tricare may request a code on the claim. |
| Under the OPPS or MS-DRG payment is anesthesia service considered package? | Yes |
| What appendix in the CPT manual provides a list of codes in which conscious sedation is considered inherent to the procedure.? | Appendix g |
| If a procedure is on the appendix g, that considers conscious sedation as part of the procedure, is it appropriate to bill for conscious sedation? | No |
| How should facilities capture the cost of conscious sedation if the procedure is on appendix g? | As part of the cost associated with the primary procedure performed |
| When can a recovery be billed? | If a patient is transferred to an area where standard post-operative monitoring and Care are provided |
| What revenue code is for recovery room? | 071X - recovery room |
| Does the recovery room revenue code need a CPT provided? | No because they are considered to be related items or services that are provided with the CPT coded procedure |
| What is cms's recommendation for facilities separately? Reporting recovery room or post anesthesia care units on the ubo4 form? | If the procedure was performed in the operating room. However, there is no regulation that prohibits services performed outside the operating room from being billed separately, as well. The recommendation from CMS is that for any procedures that require general anesthesia, the cost for anesthesia should be considered with the cost of the primary procedure provided. |
| Why are no cost devices usually the result of a manufacturer providing the item at no charge? | There is a new device for the physician to sample or there is an indegent patient needing the device. |
| When will a manufacturer provide a credit( full or partial (when a device is removed and replaced? | The device found while under warranty There is a device recall |
| What are the guidelines for billing for no-cost devices? | Usually there is a token charge of a dollar or less When billing replacement device condition code is needed for reason: Condition code 49. 9: device not working properly; replaced earlier than expected ; used when credit is 50% or more Condition code 50: device recalled by FDA or manufacturer; credit is 50% or more Condition code 53: initial placement part of clinical trial or free sample. Value code FD needs to be on both outpatient and inpt claims with the amount of device credit. |
| Scenario: patient has a device that must be replaced due to a recall. The credit from the manufacturer for the removal of the device is equal to the cost of the new device. Remove device cost equals $15,000 New device cost equals 11,000 Credit equals $11,000 What condition code and what is the value for the value code FD | Condition code 50 must be reported. The FD value code must be reported with $11,000 in the amount filled. |
| Scenario: the patient has a device that is not working properly and must be removed and replaced. The device is under warranty. The warranty credit is equal to the cost of the removed device but less than the cost of the New device. Warranty credit equals $15,000 Cost of the removed device equals $15,000 Cost of the new device equals $18,000 Hospital charge for removal equals $20,000 Hospital charge for new device equals $24,000. What is the condition code and the amount for the value code? | Condition code is 49 and the value code must be reported with $15,000 in the amount Field |
| Scenario: patient has a device that is not working properly and must be removed and replaced. Device under warranty. Warranty. Credit is less than the cost of the removed device in new device. Warranty credit equals $3,000 Cost of removed device equals 5,000 Cost of new device equals 5,000 Hospital markup for this device equals 75% What is the condition code in the value for the value code? | Condition code 49 and $3,000 for the value code |
| What is an effective way to capture no cost or discounted device information? | A device communication form |
| What item should be listed on a device communication form? | Pt account info to include pt's name, account #, DOS For non-replacement devices: device type, whether the device was provided at no cost For replacement devices: device type, model/SN, reason for replac, whether vendor sub req are completed, date the device return to vendor, weather off obtain, weather. Obtain, weather explanted device was org implanted in same fac, estimated life remaining of implanted device, whether credit received, cost for new replacement, cost for current explained device |
| What are the two cardiac catheterization CPT code families? | Congenital heart disease and non-congenital heart disease |
| What are most cardiac catheterization procedures now coded with a CPT code which includes? | Most injection procedures, imaging supervision, interpretation and report, contrast injection to image access sites, closure device placement at the vascular access site |
| What do the CPT codes created for a left heart? Catheterization other than those for CHD include? | Intra procedural injections for left ventricular/ left arterial angiography, imaging supervision, and interpretation |
| Are injections for the right heart? Catheterization allowed to be reported separately | Yes |
| What do non-Chd coronary catheterization codes include? | Catheter placement, intra procedural injections for coronary angiography, imaging supervision, and interpretation |
| What CPT codes could be used for non-chd right heart and or left heart catheterization without coronary artery? Catheterization | 93451- Right heart 93452- left heart 93453- right heart and left heart |
| What are the CPT codes for coronary artery catheterization for coronary geography? | With Rh or LH Cath: 93454- without bypass graph and geography, 93455- with bypass and geography With RH and/or LH cath, but without a bypass graph angiography: 93456- Right heart, 93458- left heart, 93460- right and left heart Rh and/or LH cath and with a bypass graft angiography: 93457- right heart, 93459- left heart, 93461- right and left heart |
| What does lower extremity revascularization now include? | Catheterization Road mapping Completion of an angiography Surgical procedure code for intervention Radiology supervision in interpretation Embolic protection Open or percutaneous access Use of of an arterial closure device |
| Since cardiac cath have been built on progressive hierarchies with the more intensive services inclusives of the lesser intensive services, how are multiple billed? | One revascularization code can be reported for each vessel that is treated. The code would represent the most intensive service performed |
| If an endomyocardial biopsy, CPT code 93505, is performed during a cardiac catheterization, can the catheterization be reported separately or is it considered an integral component of code 93505? | 93505 should be reported in addition to the component cardiac cath coats. Exception: if the physician performs the cardiac cath only as a means of attaining the endomyocardial biopsy and does not perform a separate diagnostic heart cath, then only the endomyocardial biopsy can be reported |
| According to CMS, what is the definition of an implantable automatic defibrillator? | An electronic device that is designed to detect and treat life-threatening tachy arrhythmias. This device consists of a pulse generator and electrodes for sensing in defibrillating. |
| What are the CMS guidelines in order for an implantable automatic defibrillator to be covered? | Doc episode of cardiac arrest due to ventricular fib Sustain ventricular tachyarhythmia which can be either spontaneous/induced that is not associated with a MI Doc family conditions high risk or life-threatening ventricular tachi arrhythmia Pt has coronary artery dx with a prior mi and measured lt ventricular inject fraction of ≤ .35. Mi must have been been more than 40 days prior Etc. |
| What are some items that should be documented in the patient's chart for use of cardiac catholication lab? | Specific devices or supplies used, any IVs, angioplasty, arthrectomy, patient's history, access sites, heart chambers entered, vessels, catheterized and injections, interpretations of findings |
| What are the three procedure codes for reporting heart catheterizations without coronaries? | Right heart catheterization Left heart catheterization Right and left heart catheterization |
| How many cardiac catheterization codes can be billed per sessions? | Only the primary code |
| What is inclusive of cardiac catheterization procedures? | Conscious sedation, catheter introduction, intercoronarial artery injections of pharmacy meds, sheath placements, recordings of any pressure readings in the heart, chambers or vessels, an evaluation of the findings |
| Why is Heparin bath of a catheter use drain a procedure? | Routinely used to prevent clots from forming on catheters and wires |
| What must be in the patient's chart in order for heparinized catheters to be charged? | A valid physician's order, height and weight for dosing, documentation in the medical record that is signed and dated by a person who administered the drug |
| If a valid order and completed Mar cannot be located for Hepburn ice catheter, can it be charged? | No |
| If Hepburn is provided and used to bathe the catheters as part of the procedure, do you charge an Administration service for medication? | No since it wasn't an injection or a infusion |
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