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Tools and Resources for Life Care Planners

By:  Christine Woolstenhulme, QMC, QCC, CMCS, CPC, CMRS
Published:  October 2nd, 2018

For a Nurse Lifecare planner, the Future Medical Cost Projections and Past Medical Bill Reviews requires many resources, it is vital to have everything needed for pricing, and code information in one place to save time and frustration. To get started visit the Nurse Life Care Planner Topic page, where we have gathered information used specifically for LifeCare Planners.

Find-A-Code subscribers have access to one system providing a single destination to get pricing information needed for care planning. It is easy to approximate the cost of procedures using our SaaS-based software.

Find-A-Code is a great source of information for pricing, searching procedures, diagnosis codes, drugs, durable medical supplies, rules, guidelines and much more. Use this article as a resource for Find-A-Code’s tools and search products to navigate and develop a greater understanding of and easy access to the following: ASCs, APCs, NCCI Edits, codes and how they are reported, and fees. Use the search tools to find information on DME, Drugs, pathology, and much more.

Fee information includes:

  • Medicare fees
  • UCR pricing
  • Average Billed Charges to Medicare
  • Drug Pricing
  • Durable Medical pricing

Find-A-Code fees include facility and non-facility pricing for procedures, durable medical supplies, drugs, labs, as well as information pertaining to how CPT and ICD-10 codes are reported and used.

Depending on the location, there are different charges and codes associated with patient care. Keep in mind that facility fees are separate from professional fees, which are charges for the physician’s work only. The Medicare Advisory Committee stated, “Facility fees can increase the total cost of a service by three to five times compared to the same service provided by an independent physician.” The difference being, if the same procedure can be performed in an independent physician’s office, it costs much less than if that same physician performs the same procedure in a facility that is owned by a hospital.

Hospital and Facility Fees – Patients are charged for the use of the hospital facility and the equipment, including staff working for the hospital. Hospitals may also charge facility fees for outpatient services. The facility fees payment schedule includes hospital, outpatient surgery center, and skilled nursing facilities or any location that bills for Medicare Part A.

Non-Facility Fees – Non-facility fees include provider charges, outpatient clinics, urgent care centers, and home services provided anywhere except hospital and facilities. These locations would bill Medicare Part B.

UCR Fees – UCR Fees provide usual and customary costs for Non-Medicare patients.

Search Options

Find-A-Code’s comprehensive search offers keyword searching and predictive spelling for quick results. Be sure the code or information selection on the left side of the screen is checked n order to get quick search results.

To find a diagnosis or other code you have several search options, use Click-A-Dex,  simply look under ICD-10-M codes or use the Comprehensive search (be sure to select only ICD-10-CM on the right side of Comprehensive the search tool). 

Understanding how the code sets are grouped

Code(s)   Description
A00.0 B99.9     1. Certain infectious and parasitic diseases (A00-B99)
C00.0 D49.9     2. Neoplasms (C00-D49)
D50.0 D89.9     3. Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)
E00.0 E89.89     4. Endocrine, nutritional and metabolic diseases (E00-E89)
F01.50 F99     5. Mental, Behavioral and Neurodevelopmental disorders (F01-F99)
G00.0 G99.8     6. Diseases of the nervous system (G00-G99)
H00.011 H59.89     7. Diseases of the eye and adnexa (H00-H59)
H60.00 H95.89     8. Diseases of the ear and mastoid process (H60-H95)
I00 I99.9     9. Diseases of the circulatory system (I00-I99)
J00 J99     10. Diseases of the respiratory system (J00-J99)
K00.0 K95.89     11. Diseases of the digestive system (K00-K95)
L00 L99     12. Diseases of the skin and subcutaneous tissue (L00-L99)
M00.00 M99.9     13. Diseases of the musculoskeletal system and connective tissue (M00-M99)
N00.0 N99.89     14. Diseases of the genitourinary system (N00-N99)
O00.00 O9A.53     15. Pregnancy, childbirth and the puerperium (O00-O9A)
P00.0 P96.9     16. Certain conditions originating in the perinatal period (P00-P96)
Q00.0 Q99.9     17. Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
R00.0 R99     18. Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
S00.00XA T88.9XXS     19. Injury, poisoning and certain other consequences of external causes (S00-T88)
V00.01XA Y99.9     20. External causes of morbidity (V00-Y99)
Z00.00 Z99.89     21. Factors influencing health status and contact with health services (Z00-Z99)
A04.7 Z98.89     -/+ Deleted, Replaced, Expanded Codes

Check out the following steps to locate a Fracture to the right Patella

Code(s)   Description
S80.00XA S80.929S     S80 Superficial injury of knee and lower leg
S81.001A S81.859S     S81 Open wound of knee and lower leg
S82.001A S82.92XS     S82 Fracture of lower leg, including ankle
S83.001A S83.92XS     S83 Dislocation and sprain of joints and ligaments of knee
S84.00XA S84.92XS     S84 Injury of nerves at lower leg level
S85.001A S85.999S     S85 Injury of blood vessels at lower leg level
S86.001A S86.999S     S86 Injury of muscle, fascia and tendon at lower leg level
S87.00XA S87.82XS     S87 Crushing injury of lower leg
S88.011A S88.929S     S88 Traumatic amputation of lower leg
S89.001A S89.92XS     S89 Other and unspecified injuries of lower leg

From here you select where the fracture is located. S82.0 Fracture of patella

Code(s)   Description
S82.001A S82.099S     S82.0 Fracture of patella
S82.101A S82.199S     S82.1 Fracture of upper end of tibia
S82.201A S82.299S     S82.2 Fracture of shaft of tibia
S82.301A S82.399S     S82.3 Fracture of lower end of tibia
S82.401A S82.499S     S82.4 Fracture of shaft of fibula
S82.51XA S82.56XS     S82.5 Fracture of medial malleolus
S82.61XA S82.66XS     S82.6 Fracture of lateral malleolus
S82.811A S82.899S     S82.8 Other fractures of lower leg
S82.90XA S82.92XS     S82.9 Unspecified fracture of lower leg

Next, select the type of fracture - If this information is not available, select Unspecified or query the provider for more detailed information.  

Code(s)   Description
S82.001A S82.009S     S82.00 Unspecified fracture of patella
S82.011A S82.016S     S82.01 Osteochondral fracture of patella
S82.021A S82.026S     S82.02 Longitudinal fracture of patella
S82.031A S82.036S     S82.03 Transverse fracture of patella
S82.041A S82.046S     S82.04 Comminuted fracture of patella
S82.091A S82.099S     S82.09 Other fracture of patella

Then chose Right, Left or Unspecified if there is no information available. 

Code(s)   Description
S82.001A S82.001S     S82.001 Unspecified fracture of right patella
S82.002A S82.002S     S82.002 Unspecified fracture of left patella
S82.009A S82.009S     S82.009 Unspecified fracture of unspecified patella

The appropriate 7th character is to be added to all codes from category S82.  Since this is still in the initial phase of treatment, use A- Initial encounter for closed fracture.

S82.001AUnspecified fracture of right patella, initial encounter for closed fracture

Comprehensive Search

Now that you have an understanding of how code sets are grouped let's use the Comprehensive search. For example, simply type in the desired description and be sure the CPT or code type is checked to narrow search results to only CPT codes.

TIP: Select “SHOW KEYWORDS & CONTEXT” to view the keywords searched (directly below the search results).

Click-A-Dex Index Searching

TOOLS > Click-a-Dex

Use Click-A-Dex to perform a quick search of a code set, presenting like the index system of a codebook. For example, to look up “Spinal Fusion,” select the CPT Index, enter the word “FUSION” then select “SPINE,” where you now have the option of selecting “Lateral,” “Anterior,” “Posterior,” or “Arthrodesis” procedures. Select “ANTERIOR,” then your options are narrowed down to the exact code: 22558 ARTHRODESIS ANTERIOR INTERBODY LUMBAR.

Browse-A-Code

HOME > Coding Tools > Browse-A-Code

This tool offers a code selection decision tree. Start with the section and navigate through the nearby code ranges to drill down to the exact code.

Durable Medical Product Search

HOME > Code Sets > HCPCS Codes > DMEPOS Product Search (under Coding Tools)

Using the DMEPOS product search makes searching for a product or supply simple with the ability to search Product and HCPCS codes by the manufacturer, product, model, or HCPCS using the “DMEPOS Product Search”

Drugs and Pharmaceuticals Search

TOOLS > WK Drug Database

Use the WK Drug Database to search by drug name, keyword, NDC, or GPI. This unique tool offers information about drugs and pharmaceuticals that can be used to detect, treat, or monitor diseases, as well as assist in medical procedures. Start your search with a keyword or code and click on an index letter to see drugs by name, drill down through the GPI hierarchy, or view Average Wholesale pricing (AWP).

Medical Lab Tests

TOOLS > Medical Lab Tests

Medical Laboratory Test Information also includes Clinical Lab Decision (CLD) rankings. CLD uses a proprietary ranking system that enables healthcare providers to correctly select and order the most relevant tests based on diseases, symptoms, and ICD-10 codes.

Fees

Fees are located on each individual code information page. Simply search the desired code and open the code information page by simply selecting the ENTER button. Once on the code information page, click the green bar labeled “Fees.” Fees are calculated by Medicare for specific jurisdictions, depending on the geographic location previously set up in your account. The location can be changed at any time to any other location previously set up in the “ACCOUNT” tab, using the “LOCATION” drop-down at the top of the page. Depending on your subscription, you may also have fees available for UCR, Medicare most billed charges, and OWCP fees. Simply open the Fee Schedules Bar to view these fees.

Find-A-Code offers allowable fees for Facility (Hospital), Non-Facility (Office), APC, and ASC. View fees based on participation or non-participation with Medicare, as well as add a percentage to your fee schedule to increase Medicare fees to your fees.

Nurse life care planners often provide usual and customary (UCR) costs in plans that do not include Medicare. UCR fees can be found on each code page under the Fee Schedules tab. For an industry-wide baseline, you can view the physician billed amount with Medicare Services and Charges History.

NCCI Validator

Use the NCCI Validator for facility or non-facility to see if there are edits, errors or warnings when reporting multiple procedure codes that should not be billed together. Understand which codes may be overridden with a CCI-associated modifier and which codes will be paid using a CCI modifier.

View the top modifiers billed to Medicare or all modifiers that have been reported to Medicare and the frequency of use. This information can also be found on the code information page of any CPT or HCPCS codes.

Pricing Tools

ASC Payment Calculator

TOOLS > ASC Payment Calculator

There are several tools commonly used to project pricing and are available to Find-A-Code subscribers. Use the ASC Calculator to assist in projecting fees in the ASC setting.

APC Packager/Pricer

TOOLS > APC Packager/Pricer

One of the most popular tools used for APC is the APC Packager and Pricer, which comes with the hospital add-on tools. Enter all claim information to get payment details for date ranges, based on a specific hospital, patient information, and diagnosis codes.

Pro Fee Calculator

TOOLS > Pro Fee Calculator

Let’s look at a spinal procedure for a lumbar fusion using a simple way to price physician charges using the Pro-Fee calculator.

Once in the professional fees calculator enter the desired procedure codes, including modifiers and units if applicable. Select the option of Non-Facility, Facility, or Non-participating. The reimbursement calculator will give you fees based on the geographic location, so be sure to enter the ZIP code where the service is being performed. 

Select the “NCCI Check” to view NCCI edits and vital coding information pertaining to the list of codes, use the “Sort By RVUs” button to sort by RVUs, reporting the highest RVU/pricing first.

The red error flag lets you know there is an editing error and gives the rationale of the error with coding instructions noting if the procedure can be overridden with a CCI-associated modifier. Results are shown below the calculator. Make the needed corrections and recalculate to ensure correct reporting and reimbursement.

MS-DRG Grouper

Diagnosis-related group (DRG) is a system to classify hospital cases into one of approximately 500 groups, also referred to as DRGs, expected to have similar hospital resource use. 

DRG Grouping is the method used to assign a DRG based on the diagnoses made and procedures performed for a particular patient's case. It takes into account the principal diagnosis, any secondary diagnoses that may act as complications, as well as the procedures (either surgical or non-surgical). In some cases, gender and discharge status are also required to group a case into a DRG. Only one DRG is assigned for each case, so Grouping finds all applicable DRGs and assigns the highest severity DRG that applies.

Example:

64 YO Female is admitted with a fracture of her right patella Surgery is to repair the fracture

Diagnosis: S82.001A - Fracture of right Patella

Procedure: 0QQD0ZZOpen repair of fractured right Patella

Enter the diagnosis code under Principal Diagnosis, using ICD-10-CM codes or ICD-9

The condition was Present on admission (POA), select Y on the drop down. Enter the Procedure code using PCS codes for this grouper. 

Enter Discharge date

Admitting Diagnosis

Age

Gender

Discharge status

Select GROUP at the bottom of the grouper, the results will be displayed below with a grouping summary and DRG result with pricing.  

This information can all be found on the HELP page (located in the upper right corner of any page), which includes page index site, web links, videos, and tutorials to support your Find-A-Code subscription.

Find-A-Code support staff is available to help you with questions concerning your account and search options. Give us a call at 801-770-4203 or visit our Live Chat for assistance.

Christine Woolstenhulme, QMC, QCC, CMCS, CPC, CMRS 

Chris.Woolstenhulme@findacode.com

Find A Code. LLC 62 E 300 N Spanish Fork UT 84660 www.findacode.com

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