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APS Billing Primer

Weekdays APS billing at Bayview & HOAC
  • Print extra list in morning before you start rounding for billing. Submit this list once coded to the billing office.
  • Only bill for patients actually seen by either yourself or one of the APS NP’s.
  • Patients enrolled via OR: APS does not bill the enrollment. The attending in the OR bill C015 & C101. If patient went to OR while enrolled on APS check with attending if they will be billing any APS codes.
  • New APS consults: Bill either C215 (elective in-patients) or A215 (all other patients). Add C101 if consult done in PACU, CrCu, CVICU, B5ICU, D4, BurnICU, CCU (cardiac ICU) or SCU at HOAC.
  • Follow up visits: regardless of modality, bill C014 (add C101 for patients in PACU, any ICU or SCU at HOAC)
  • If you insert any blocks on APS patients - please bill blocks codes (G260, G060, G061 +/- G279) accordingly. Add E409 (>1700) or E410 (2400-0700)
  • E420 (ISS>15, ASA 4) trauma code also applies to consults/assessments and visits for the first 24 hrs.
  • Weekdays after hours assessments: bill A014 plus premiums C962 & C994 (first patient 17:00-2400), C995 (subsequent patients 17:00-2400) or C964 & C996 (first patient 2400-0700), C997 (subsequent patients 2400-0700).
  • The individual on pain service is RESPONSIBLE for ensuring services are billed on the change over day (Monday).
    Weekends / Holidays APS Billing

    Bayview
    • Again, enrollments are billed by the attending in the ORs.
    • Regardless of modality, bill A014+C963+C986 for the first patient.
    • Then A014+C987 for each subsequent patient up to 20 patients max.
    • For patients with catheter / epidural, bill G47+E402 but ONLY after 20 cases of A014+C987 billed (if you visit a patient with catheter more than once, it can be billed up to 3 times per patient per day, but must leave a note each time).
    • Add C101 for any patient in PACU or any ICU.
    • New APS consults: Bill either C215 (elective in-patients) or A215 (all other patients). Add C101 if consult done in PACU, CrCu, CVICU, B5ICU, D4, BurnICU, CCU (cardiac ICU) or SCU at HOAC.
    • If you insert any blocks on APS patients - please bill blocks codes (G260, G060, G061 +/- G279) accordingly. Add E409 (weekends/holidays) or E410 (2400-0700)
    • E420 (ISS>15, ASA 4) trauma code also applies to consults/assessments and visits for the first 24 hrs.
     
    HOAC
    • APS enrollment billed by each staff in OR - A215+C101+C963+986 for first patient, and A215+C101+C987 for subsequent patients.
    • For the APS list, HOAC staff #1 bills A014+C987 for first 16 patients (assuming they have billed APS enrollments / consults for the 4 OR cases). HOAC staff #2 bills A014+C987 for the remaining APS patients. Add C101 for those patients in SCU.

     

     

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