Master your chargemaster: is your hospital's chargemaster friend or foe? It's a vital element in the revenue cycle, but it can present challenges

Healthcare Financial Management, Sept, 2005 by Duane C. Abbey, Jodee E. Collins

For vascular catheterizations, coding and billing become quite complex. Component coding is used, which generally includes a surgical component (30000 series in CPT) and a radiological component (70000 series in CPT), and these components must correlate. Because multiple services may be provided, multiple code combinations become the norm. Also, the complex coding guidelines may create certain bundling situations. Thus. using static coding for vascular catheterizations becomes problematic. When both coronary and vascular procedures are performed during the same interventional session, the way in which the codes and modifiers are developed and eventually appear on the claim form becomes an area for considered study.

Even if static coding is feasible, the technicians entering the charges should be fully versed in all coding conventions and proper use of modifiers, including the -LT, -RT, and -59 modifiers. They should code a case by selecting the proper line-item charges and ensuring that the proper modifiers are in place. When static coding is used, a sampling of vascular catheterization claims can determine if the claims are being correctly generated. Most likely, such an audit will show that this approach is not feasible for some hospitals.

An alternative approach is to have the radiological component codes developed statically and have the surgical component codes developed by professional coding staff (i.e., dynamically). Then the radiology and surgery codes should be checked to make sure they correlate before the claims are finally developed.

In a slight variation on this process, the technicians enter all charges (radiological and surgical), professional coding staff develops the surgical codes from the physician's documentation, and a reconciliation is performed to ensure that all the codes and necessary and appropriate modifiers are present and that the radiological and surgical codes align. Note that the physician's claim and hospital's claim also should be the same, with the exception of modifiers. Because the UB-92 and CMS-1500 will most likely be filed by separate organizations, accurate correlation is essential.

Taking this process to an even higher level, the coding can be driven directly by the physician's documentation. This process requires a documentation system that allows the physician to input the various services provided. In theory, such a system would document the case and generate the proper codes, which would then also drive associated charges, modifiers, and the like. The hospital would still have to charge for various supplies, such as catheters, which require the use of Level II HCPCS C-Codes.

These two approaches, depicted in the exhibits, show that chargemaster coordinators should consider alternative ways of setting up and interfacing the chargemaster to other functions in the payment cycle with particular attention to coding and billing.

Archiving Chargemasters for HIPAA

With the implementation of the Health Insurance Portability and Accountability Act of 1996 transaction standard/standard code set rule, the standard code sets are in place for specific periods of time. Thus, changes to the chargemaster to accommodate new and/or changed CPT, HCPCS, and revenue codes can be made only at specific times. Although major updates for these coding systems occur once a year, quarterly updates are becoming increasingly common.