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

Chargemaster, Charge Description Master, CDM, theyall refer to the "list" of your facility's billable items. Everyhospital has one. Every hospital at one time or another has gone througha dreaded computer conversion, (when you change from one system toanother) and every hospital should update their CDM on a quarterly basisfor OPPS pass -through items and yearly for the other departments. Doesyours?

So, how is the CDM set up? Each department in yourhospital is assigned to a cost center. Usually the first three or fournumbers in a series of numbers represent that center. Then, the nextfour to six numbers represent the specific item that the cost centerbills. 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 number222-1235, followed by EandM Level III being 222-1236 and so on. Eachitem in the ED will be assigned to the 222 cost center and then beassigned it's own four digit number.

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

Each new item or service provided by a cost centergoes through a review process that looks at the item, determines if itrequires a CPT code (not every items does), uses a multiplier to set thepatient'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 whereit will be listed on the UB92. This entire process usually involvesstaff from Patient Accounts, Medical Records, the requesting department,Info Systems and Finance, although your hospital may have a variationof this. Find out how this process works at your own facility.

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

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

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

•Do the service items map to the correctrevenue code as assigned by HCFA for OPPS? (Hint: See Program Memo A01-50 recently issued by HCFA changing which items go with certain Revcodes effective 1/1/02.)

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

•Are the Modifiers required on the appropriate line item?

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

Items with CPT/HCPCS codes built into the CDM arereferred to as "hardcoded" whereas the items that have CPT/HCPCSassigned by HIM are called " softcoded". The description for the CDM isusually limited to 25 to 30 character spaces that can and does call forsome creative abbreviations. The thing to remember is to be consistentwith those abbreviations throughout the entire CDM. Also, when settingup the description, try to use the common noun first, followed by themain adjective then proper noun i.e. cath, foley Bard or cath, triplelumen. Using this method allows you to do an alpha sort of your entirefacility CDM and every cath, triple lumen from every department usingthem will fall together. The finance department can make sure the priceis the same from all areas using like items. But, be consistent if youuse that comma or else an alpha sort will repeat the sort first withoutcommas, then with commas and be a nightmare for anyone trying to find aspecific item.

Breaking the above rule!

With APCs, many hospitals are finding it difficultto append the correct modifiers to repeat procedures and service.(Helpful hint: Set the repeat lab test, EKG or chest X ray in the CDMwith 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 thestaff it will automatically be hardcoded with the appropriate modifier(76) that indicates to HCFA and passes through the OCE that it is arepeat test. Review which lab tests are often repeated, such aspotassium, and do the same thing using modifier 91 in that instance.