I spoke withour in-house expert about this, and we're of the opinion that in
this case, the Imp Guide is less restrictive than the Final Rule, and we
need to follow the Final Rule. The guide provides for both codes, but the
rule restricts the use.
Check out pg 50325, middle column, bottom of page "The use of ICD-9-CM
procedure codes is restricted to the reporting of inpatient procedures by
hospitals"
Then the preamble states "If a health plan currently requires health care
providers to use CPT-4 to report inpatient facility-based procedures, they
both would be required to convert to ICD-9."
So we're thinking that all outpatient procedures must be reported with
CPT-4/HCPCS, and inpatient procedures must be ICD-9.
-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]
Sent: Wednesday, August 29, 2001 6:00 AM
To: [EMAIL PROTECTED]
Subject: Re: ICD9 Procedure Codes vs HCPCS Procedure Codes
Part of the answer lies in where this information is reported in the 837.
For instance, at the line level (2400 loop, SV202segment, pg.446 in the IG)
where the HCPCS can be reported, the note specifies "required for all
Outpatient claims". This is not something out corp. currently requires of
facilities, but I suppose it will be sent.
-M.J.L.
"Jim Moores"
<Jim.Moores@AntaresSolu To: [EMAIL PROTECTED],
[EMAIL PROTECTED], [EMAIL PROTECTED]
tions.com> cc: "George Kaye"
<[EMAIL PROTECTED]>
Subject: ICD9
Procedure Codes vs HCPCS Procedure Codes
08/28/2001 04:29 PM
Please respond to
transactions
Hi All,
I think that this is an easy question (I hope). When we price Outpatient
Surgeries we use the APG system that uses both the ICD9 Procedure Codes and
the HCPCS Procedure Codes (so I've been told). Both data elements are in
the 837 I transaction.
The question: The 837I IG is unclear if we can require BOTH procedure
codes for outpatient claims... The HCPCS seems to be situational, but
without comment. I've read that no comments means "send it if you've got
it". The difference is, we need to price accurately.
Bottom line: Can we require Institutional Providers of Care to send us
both for Outpatient Claims in some sort of contractual arrangement (network
contract).
Any comments and observations gratefully accepted.
Thanks all,
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