4.3 Case Study

Please view the video below, use your course textbooks, and the CMS website to research your responses to the questions asked in your case study. For questions 2 & 3 you will need to provide a 1-2 paragraph response that justifies your opinions by citing at least one source per question.

Your organization has a physician who is performing total anterior lumbar arthroplasty with artificial discs on an outpatient basis. Unfortunately, after several have been performed and billed, you get a memo from the business office stating that there are denials for Medicare patients. The billing manager states that it is something about a status indicator C. She would like you to review the CPT code assignment(s) and help determine what the problem is and how it can be resolved because the charges for these procedures exceed $65,000 per case. After reviewing the cases, the CPT code assigned is correct.

22857Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), single interspace, lumbar - denotes a status indicator of C for that CPT code

Please answer the following questions:

1. Explain to the billing manager what status indicator C means and how this has resulted in the denials.

2. In order to facilitate a prompt resolution to this issue, you and the billing manager decide to create a process improvement team. Decide what hospital departments should be part of the team.

3. Brainstorm at least three possible solutions to the problem.