Explain why this resource would be beneficial to a coder. (read the article below)

Chargemaster, Charge Description Master, CDM, they all refer to the “list” of your facility’s billable items. Every hospital has one. Every hospital at one time or another has gone through a dreaded computer conversion, (when you change from one system to another) and every hospital should update their CDM on a quarterly basis for OPPS pass -through items and yearly for the other departments. Does yours?

So, how is the CDM set up? Each department in your hospital is assigned to a cost center. Usually the first three or four numbers in a series of numbers represent that center. Then, the next four to six numbers represent the specific item that the cost center bills. In our fictitious St. George Hospital, it could look like this:

222-1234 which translates into 222 (ED cost center) and 1234 EandM Level 1. EandM Level II would likely be the next number 222-1235, followed by EandM Level III being 222-1236 and so on. Each item in the ED will be assigned to the 222 cost center and then be assigned it’s own four digit number.

This method of assigning numbers allows the hospital to repeat the individual item numbers (if necessary) for other types of supplies or services in different departments because the cost center number changes. Therefore, the OR (cost center 433) could very well have an ortho pack using item number 1234 (433-1234) or Radiology (cost center 555) could have a knee X ray with the 1234 number scheme.

Each new item or service provided by a cost center goes through a review process that looks at the item, determines if it requires a CPT code (not every items does), uses a multiplier to set the patient’s charge based on a cost formula and gives it the item number. It also is mapped to a revenue code. The revenue code determines where it will be listed on the UB92. This entire process usually involves staff from Patient Accounts, Medical Records, the requesting department, Info Systems and Finance, although your hospital may have a variation of this. Find out how this process works at your own facility.

The majority of requests for additions or deletions coincide with the new CPT and HCPCS codes that become effective January 1 of each year. HCFA almost always allows a 90-day grace period until April 1 of that year to phase out newly deleted codes and the implementation of any new codes. However, with the start of OPPS we now have new pass-through items quarterly.

Each cost center is given a revenue usage report on a monthly basis that shows which items from that cost center were billed in the previous month. This is a tremendous tool for auditing the services provided by your staff and in determining staffing needs. It is often used as an inventory control for supply items. Some reports may even show the breakdown of usage by financial class (Medicare, Medicaid, BCBS, Self-Pay and HMO) and also by inpatient or outpatient use. This report is especially useful when a chargemaster review is taking place as it helps to weed out items no longer billed by a department. Other questions to ask are:

• Does the CDM really have every billable item or service in it? As a test, take the list of available CAT Scan CPT codes and see how it compares to the ones offered by your CT department. (Hint: New CPT coded procedures may be missing from the list or it could also be that those procedures are just not done at your facility.)

•Do the service items map to the correct revenue code as assigned by HCFA for OPPS? (Hint: See Program Memo A 01-50 recently issued by HCFA changing which items go with certain Rev codes effective 1/1/02.)

•Does the CPT code assigned to a line item match the description? (Is the line item description a three-view X ray but the CPT code description a two-view X ray?)

•Are the Modifiers required on the appropriate line item?

•Is the price within an acceptable price range or over the years have those yearly 5-10% price increases drastically distorted the charge?

Items with CPT/HCPCS codes built into the CDM are referred to as “hardcoded” whereas the items that have CPT/HCPCS assigned by HIM are called ” softcoded”. The description for the CDM is usually limited to 25 to 30 character spaces that can and does call for some creative abbreviations. The thing to remember is to be consistent with those abbreviations throughout the entire CDM. Also, when setting up the description, try to use the common noun first, followed by the main adjective then proper noun i.e. cath, foley Bard or cath, triple lumen. Using this method allows you to do an alpha sort of your entire facility CDM and every cath, triple lumen from every department using them will fall together. The finance department can make sure the price is the same from all areas using like items. But, be consistent if you use that comma or else an alpha sort will repeat the sort first without commas, then with commas and be a nightmare for anyone trying to find a specific item.

Breaking the above rule!

With APCs, many hospitals are finding it difficult to append the correct modifiers to repeat procedures and service. (Helpful hint: Set the repeat lab test, EKG or chest X ray in the CDM with the word “Repeat” listed first.)

For example, in the ED have a CDM line item for “EKG” and another one for “REPEAT EKG” When the item is selected by the staff it will automatically be hardcoded with the appropriate modifier (76) that indicates to HCFA and passes through the OCE that it is a repeat test. Review which lab tests are often repeated, such as potassium, and do the same thing using modifier 91 in that instance.

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