Tools and Resources for Life Care Planners

Life Care Planners play a vital part in a patient’s health and wellness. With so much information required for a single patient, it is vital to have everything needed for pricing, and code information in one place to save time and frustration.

Understanding the progression of a disease and lifetime clinical treatment options is complicated enough without the correct tools for research and pricing. This is where Find-A-Code can assist Nurse Life Care Planners. With your subscription to Find-A-Code, you no longer need to search the internet or use multiple websites, because the work has already been done for you and is available all in one place.

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 also a great source of information for pricing, searching procedures, diagnosis codes, drugs, durable medical supplies, 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

• OWCP pricing

• Average Billed Charges to Medicare

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 quicker search results.

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 for 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. Another tool to assist in projecting fees in the ASC setting use the ASC Calculator.

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.

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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