Examine the chartmaster (CDM) illustrated below:

Charge Number	Charge Description	Charge	CPT Code
Charge Number	Charge Description	Charge	CPT Code
42364527	Chest x-ray, single view	$89.75	71010
42364528	Chest x-ray, two views	$110.75	71020
49533561	CT scan, thorax w/o contrast	$450.25	71250
49533562	CT scan, thorax, w/contrast	$525.660	71260
49533563	CT scan, thorax w/o and w/contrast	$611.20	71270
59781213	MRI chest, w/o contrast	$985.00	71550

Examine the portion of the chargemaster illustrated above. Identify the missing elements that should be included for a complete chargemaster and explain their necessity. Below is a table of the basic content of CDM, including any elements from here and any other ones found from outside resources (include references).

Table 5.5. Basic content of a charge description master (CDM)

Field	Description	Example
Charge Code	The facility's unique identifier for the specific charge. A hospital with outpatient services may have tens of thousands of charge codes. The codes may be assigned sequentially, as needed. Howeverm the more logical assignment strategy is to link the sequence to the responsible department. However	54100243 In this example, 541 is the department code for respiratory services
Item description	The facility's description for the charge. The description should adequately differentiate between similar charges. In other words, multiple charges may have similar or identical descriptions; however, the HCPCS codes or revenue codes for the various charges vary. Therefore, the charge descriptions must be reviewed and amended to make the distinctions among charges clear.	Pulm Rehab 1 on 1 per 15 min. versus Pulm Rehab Therap Proc Group
General ledger (GL) key	This code links the individual charge to the facility's accounting system	3 = gross patient charges
Revenue code	The four-digit Medicare billing reference. These codes flow through to the UB (75.4-FL 42). Medicare guidelines suggest that the revenue code for a particular charge reflect the roll-up to the facility's cost report.	0410 - General Classification Respiratory Service Detail: 041X is Respiratory Services 0-General classification (Respiratory SVC) 2-Inhalation Services (Inhalation SVC) 3-Hyperbaric Oxygen Therapy (Hyperbaric O2) 9- Other Respiratory Services (Other Respir SVS)
Insurance code mapping (Mapping is also often referred to as pointers because the CDM is built to point to specific coding scenarios for a specific payer. This may also include different hard-coded modifier options by payer).	These fields enable the assignment of multiple HCPCS codes and revenue codes to a single charge code. Medicare may require a specific HCPCS code for a charge, whereas a payer commercial may require a different code.	54100243 INS Code A payers require CPT code 97110, which is a nonspecific therapy code. INS Code B payers require HCPCS code G0238, which is specifically respiratory therapy.
Activity date	The effective date of the most current change. As a CDM matures, there are multiple changes that occur. Prices change, CPT code change, and some charges become obsolete. The CDM should accommodate all of the above. For example, if a HCPCS code is replaced, the CDM should have the old data available for research and printing of old claims, but the new HCPCS code would fill the field in all claims after the date changed. So, the activity date reflects the most recent update, but there will be additional fields for the effective date or the expiration data of certain charges.	5/24/2008

Reference

Davis, N., & Doyle, B. (n.d.). Revenue Cycle Management Best Practices, Second Edition.