Laureen: OK! Tammy is our instructor coach for our COC course, formerly CPC-H, our CPMA, our medical auditing course, and she’s going to be helping develop some new medical coding courses with us. We’re very appreciative of having her on the team.
Q: “Any chance we can learn more about the J1 status indicator in a webinar?”
A: I’m not sure what all you wanted to go over with the J1, so I’ll just real quick; we could be here half the night, I guess, discussing J1 status indicator, or status indicators period. But for those that are not facility coders, and you’re not familiar with what a status indicator is, we use these for payment for reimbursement on the facility side of coding.
Just very quickly, every CPT code has a status indicator that it’s attached to. These are similar to DRGs which I know everybody is familiar with, and where things are broken up into groups, and then codes are assigned into a certain group, and then there’s a certain weight assigned to those DRG groups, and that’s how facilities get paid. It’s a long, drawn out, and very, very technical to go into, which is why I did not want to go into a lot of details today.
But I will tell you that the J1 is new for 2015. It is one of 25, 26, 29; I think they went up to 26 this year, there’s three that they’re still being discussed in this. But all this status indicator is saying is that basically we’re bundling procedures. It’s a new comprehensive code, so they’re not actually APC’s, they’re C-APC is what they’re calling these, a comprehensive APC. These are typically for procedure codes in which we have to use a device, such as, if you were placing a stent whether it be a coronary stent or whether it be a vascular stent. There is a device, the stent itself is the device.
So what they’re saying for 2015 when we code that CPT code, then this J1 indicator is going to be on there saying that it is packaging the device in with the procedure. We still have to code for that device, a C-code still has to be on the claim form, but it’s only going to be one payment. It’s not going to be separate payment, like it has been in the past.
Now, the CMS is not generous by any means, but they did hike it up a little bit to help cover the cost, and in case anyone was ever under the illusion that CMS covers everything, then you’re wrong. CMS only tries to help cover your cost, not make you rich for sure.
If they have procedures, they’re doing a couple of procedures where you have J1 indicators on a couple of CPT codes. What they’ll do then is they’ll bump up to the next highest APC level so that you get paid by the higher rate, but you’re not going to get paid separately, you’re just going to get bumped up.
Kind of like E/M coding, in E/M coding if we have time on our side, if we have 50% more time, then we are allowed to bump up that CPT level, so that’s kind of like what we would do with the J1 indicator. If we have two procedure codes or more with the J1, then we just bump it up to the next APC payment group.
So, for those of you that work in a facility, I may have made sense; for those of you don’t, I was just speaking totally Greek.
Laureen: Even if we don’t do it, it’s always good to be aware of it out there, so that when we start to see things, like C-APC, we have a familiarity with it. That’s how you start. Here’s your next question.
Tammy: I had a lot more fun with this one. I had to read the question several times before I got the gist of what I hope is being asked here. The questions is a little bit lengthy, and guess what, the answer is too; so bear with me.