Charge description master is everyone’s responsibility
Expert offers guidance to staff training
The hospital charge description master is not a wild bull behind someone else’s fence. It’s the responsibility of each HIM individual, department manager, and finance person, and the only way to tame the beast is to make certain everyone knows what it is and what their part is in handling it.
"It’s absolutely important that anyone who generates any kind of information in a hospital understands what their part is on their charge description master," says Lora A. DeWald, MEd, RHIA, CCS, CCS-P, vice president of health information management for Avera Health in Sioux Falls, SD. DeWald spoke about the chargemaster at the 73rd National Convention and Exhibit of the Chicago-based American Health Information Management Association (AHIMA), held Oct. 13-18, 2001, in Miami Beach, FL.
"The charge description master is not just something that happens in the finance department," DeWald adds.
DeWald offers this advice on how to educate staff about the chargemaster and their responsibility toward keeping it accurate:
• Define the charge description master.
"A chargemaster is nothing more than lines of services provided in a facility," DeWald says. "It usually has six components per line, with the first component being the charge number."
The charge number is defined with many different terms, including the general ledger number, the hospital number, and others, DeWald says.
"It is necessary for every individual who provides charges to a bill to know what the definition for this bill is in their respective facility," DeWald says.
The charge number usually performs two functions:
— The first three or four digits identify the department in which the costs, charges, and revenue are posted.
— The next series of the number identifies the service, supply, or pharmaceutical.
The charge number is the number that is keyed into the billing system to generate a line-item bill (also called an "itemized" bill) for the services, supplies, and pharmaceuticals provided to the patient during an episode of care, DeWald explains.
"These itemized charges are eventually compiled and passed to the UB-92, where they are organized according to revenue codes," she says. "These revenue codes were developed by the National Uniform Billing Committee [NUBC] and are revised and updated annually."
DeWald points out that the revenue code is to the UB-92 what the charge number is to a claim. "These revenue codes summarize multiple items charged in a single department to one line item on the UB-92," she says.
For example, an outpatient bill for a surgical procedure may have many lines identifying items such as surgery time, equipment, and supplies. When the claim is passed to the UB-92 and submitted for payment, all of the charges for that cost center will be added up and appear as one line on the UB-92 with a revenue code of 490, DeWald says.
"This number is followed by a description of the service line, the Common Procedural Terminology [CPT] or Health Care Financing Administration Common Procedure Coding System [HCPCS], followed by the number of units described by the service line and the charges per unit," DeWald says.
DeWald suggests educating staff on how a charge description master works. "Take pieces of the chargemaster and tell how it starts out as an internally assigned department number, which determines cost centers, and how those cost centers relate to revenue centers and how important it is for the description of the CPT/HCPCS code to match what’s described in your chargemaster," she says.
It’s important that staff grasp the difference between the internally developed charge code and the NUBC revenue codes, DeWald adds.
"The other thing they need to know is that it often takes more than one CPT or HCPCS code to completely describe and bill a service," DeWald says.
• Describe ways of assigning codes to the chargemaster.
DeWald uses an example of a needle localization of a lesion in the breast to show how different codes might be used on the chargemaster. "In order to localize that lesion, occasionally they have to take the patient into the radiology department, where X-ray will be used to locate the precise location of the lesion, followed by placement of a localization wire, and then you have two charge lines," DeWald says. "There will be one for the radiology portion of that procedure, which many times is hard-coded or comes to the claim directly from the charge description master."
However, the needle localization part may be assigned by a coder in HIM or someone in radiology.
"One of the things we try really hard to do is assign as many codes as possible through the chargemaster, hard-coded, so we have as little human intervention as possible," DeWald says. "That’s our goal, and as HIM professionals and coders, the emphasis we have to make is that these code numbers must be correct, whether the codes are assigned through the charge description master or by a person."
• Check for coding accuracy.
Coders shouldn’t fear hard-coding, because it creates a new opportunity in the HIM field, DeWald adds.
"You need to monitor the code numbers driven onto the claim by the chargemaster to make sure they are still the accurate codes, because every year in January there are a lot of new codes," she says. "Last year there were more than 300 new codes — either new codes or description changes."
With the advent of the hospital outpatient prospective payment system (PPS), the Centers for Medicare and Medicaid Services is adding and/or deleting HCPCS codes on a quarterly basis, DeWald notes.
Therefore, someone needs to make certain that these codes become part of or are removed from the charge description master, and this probably will be the coder’s role, she adds. (See story on keeping the chargemaster up to date, below.)
It should be the coding professional’s responsibility to make certain that code numbers are accurate, updated, and then charged through the chargemaster, DeWald says.
"Now because most payment is based on CPT or HCPCS codes, it’s extremely important that the number be correct, because if you assign an incorrect number, your payment will be incorrect," DeWald explains. "Or you will be making a claim for a service that you didn’t provide, simply because you assigned the wrong number."
• Show staff how to take responsibility for the chargemaster.
Coding professionals often fail to understand what a chargemaster is and cannot recognize that maintaining or developing the chargemaster is part of their responsibility, DeWald says.
"There is a big reluctance on the part of many coders to accept what they see as an added responsibility," DeWald says. "They see it as something they do in finance, and We don’t do that,’" DeWald says. "But coding accuracy is more than assigning codes; it’s also checking those codes that someone else has assigned to make sure they are correct."
• Look for these future developments.
The chargemaster becomes more automated each year, and someday it might be entirely automated, DeWald says.
"Some people say that it’s already automated and we don’t need a coder, but I have an idea that this is quite a long ways in the future," DeWald says. "What will happen is that the coder will become the auditor, who will monitor to make certain these code numbers are hard-coded into the chargemaster correctly and to make auditing claims to make sure they’re coming out correctly."
DeWald predicts that as the chargemaster becomes more automated, it will provide even more work in the HIM department.
For example, coders need to be aware that a single incorrect digit on a chargemaster could result in a facility losing thousands of dollars, because all procedural codes now are the basis for Medicare payments under PPS.
The best coders are those who are methodical and have an almost obsessive personality when set to the task of determining or verifying codes, DeWald says.
"They have to have tremendous patience for details," she says. "On occasion, you might take 20 minutes to decide which part of the finger — one tendon vs. another tendon — was affected and why that’s important," DeWald says.
DeWald says that in her opinion, the best coders are those individuals who have a passion for the study of disease and trauma, but can’t stand the sight of blood.
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