Question

Your organization just opened a new service line: outpatient spinal fusions. The first cervical spinal fusions were done last week, and your coders have coded 10 of them. Unfortunately, several weeks and another 25 procedures later, you get a memo from the business office stating that there are denials on Medicare fusions (17 to date). The billing manager states that it is something about a status indicator “C”. She would like you to review the CPT code assignments and help determine what the problem is and how it can be resolved because the charges for these procedures exceed $35,000 per case.

After reviewing the cases, the CPT codes are assigned are correct.

2251-arthodesis cervical

*22845-anterior instrumentation

22851-use of biomechanical device (cage)

*20936-autograft of bone from same site

*denotes a status indicator of C for that CPT code

1. Explain to the billing manager what status indicator C means.
2. In order to facilitate a prompt resolution to this issue, you and the billing manager decide to create a process improvement team. Decide what hospital departments should be part of the team.
3. Brainstorm at least three possible solutions to the problem.

Answer 1

A.Status indicator C means an inpatient-only procedure under Medicare, meaning the organization will not receive payment for the encounter if it was done as an outpatient

B. process improvement team should include-

• PI team members
• HIM
• Patient accounting
• case management
• utilization review
• addmission and registration