This page exists to document and share questions posed by clients and answers from the ChargemasterCare™ team.
Q: Does ChargemasterCare™ address issues related to pharmacy subsystems and mapping to the chargemaster specifically as relates to proper billing units?
A: Yes, upstream pharmacy support is a specialty. Chargemaster mapping is an essential component for care and management of the Chargemaster.
Q: Have you received return-to-provider claims with Reason Code 39132 yet?
A: If you have and would like to know how to avoid them in the future, contact us at ChargemasterCare™ and we’ll give you the answer.
Q: When the nurses are entering charges on obstetric patients, what does the “antepartum testing” charge include?
A: If the physician or other qualified healthcare provider orders “antepartum testing” ask the provider specifically what test s/he needs and why. As auditors, when we find there is not a specific order and a reason (diagnosis code) for the service, whatever tests are performed are not separately billable. If the providers want to order panels – which we discourage – the providers must define the components and the medical staff committee should endorse and approve them and the circumstances under which they will be supported. However, it should be noted that hospital/clinical-specific policies, protocols, etc., in and of themselves, cannot alone justify coverage.
Q: Is there a difference on the charge/code for a “stress test” and an “NST – non-stress test”? Both the stress test and the NST are listed in our OB charge master and I wanted to know what the difference is?
A: 59020 Contraction Stress test (a.k.a. Oxytocin Challenge Test or OCT) – The physician evaluates fetal response to induced contractions in the mother. The physician applies external fetal monitors to the maternal abdominal wall. Pitocin is given intravenously to the mother to cause uterine contractions. The fetal heart rate and uterine contractions are monitored and recorded for 20 minutes to determine the effect of contractions on the fetus. This procedure is usually performed during the third trimester.
59025 Non-Stress Test (NST) – The qualified provider evaluates fetal heart rate response to its own activity. The provider reports fetal movements as an external monitor records fetal heart rate changes. The procedure is noninvasive and takes 20 to 40 minutes to perform. If the fetus is not active, an acoustic device may be used to stimulate activity. Note that the testing may exceed the typical time frames due to inactivity of the fetus or other circumstances. In such instances, it is not appropriate to charge for two NSTs nor routinely assess Observation time.
Both must be ordered by the physician or other qualified healthcare professional. They must be medically necessary.
Q: When we charge for a Bililight for a newborn, is there an initial set up charge or is it a daily charge or hourly?
A: The bililight is a piece of capital equipment that may be reused for several patients. As such, it is not separately billable. Any perceived charge for the bililight should be included in the room rate for patients in the nursery.
Q: What is the difference in newborn nursery code/charges “level I, level II, level III” and how do we capture a charge for a level II for instance?
A: These Level codes apply to the acuity of the bed that the Neonate occupies. The levels of care are represented by Accommodation Codes (Bed Charges) 0171-0174. You may find more information on pages 52-56 *Guidelines for Perinatal Care, 6th Ed. AAOP and ACOG. According to NUBC, the codes are defined as follows:
Subcategories 1 – 4 for use by facilities with nursery services designed around distinct areas and/or levels of care. Levels of care defined under state regulations or other statutes that supersede the guidelines below. For example, some states may have fewer than four levels of care or may have multiple levels within a category such as intensive care.
Level I: Routine care of apparently normal full-term or pre-term neonates. (Newborn Nursery*)
Level II: Low birth-weight neonates who are not sick, but require frequent feeding, and neonates who require more hours of nursing than do normal neonates. (Continuing Care*)
Level III: Sick neonates, who do not require intensive care, but require 6-12 hours of nursing each day. (“Intermediate Care”*)
Level IV: Constant nursing and continuous cardiopulmonary and other support for severely ill infants. (Intensive Care*)
Q: How should we bill for OB recovery room charges? Should we bill using 15 minute increments, by the hour, or as one single unit?
A: Charge in correspondence with other surgical recovery; most payors will consider normal uncomplicated vaginal delivery and recovery as a single service and will reimburse accordingly. For C-sections, recovery is treated as surgical recovery often in the same department/area as provided to non-OB patients. There is no standard unit of measure for recovery prescribed.
Q: I work at a hospital, and we are trying to implement the reporting of the functional reporting / severity codes for PT/OT/SPL (G8978-G8997). At this time we have not found guidance as to the expectation for revenue code mapping for the codes when services are performed and billed by a hospital. Would you be able to direct me to a resource for this coding determination?
A: According to an email to MedLearn from the Centers for Medicare & Medicaid Services (CMS), the 42X, 43X, and 44X revenue codes (for PT, OT and SLP) are required for each line of service with a nonpayable functional G-code on therapy institutional claims—in the same manner as required for payable procedure codes. The revenue codes correspond to the PT, OT, and SLP plan of care modifiers (GP, GO, and GN). For the functional G-codes, the 420, 430 and 440 revenue codes can be used.