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Question: MER code for combined billing for two hospitals-TSC

Hello! I hope you are doing well. We are encountering more complex situations as the CMS billing/ bundling increases. We have one smaller hospital that cared for a patient and they had their MER procedure there. They were transferred to Main Campus to continue their care. The two hospital encounters were combined for billing as one episode of care. The bill was from Main campus, not the smaller hospital. My question is how to capture the MER information for the smaller hospital. They are pursuing TSC certification and the patient did have the MER there. However, the MER code is associated with the larger hospital due to combined billing. Can we manually add the MER code to the smaller facility so that we can abstract the data for that hospital? My concern is that it was not billed that way but the MER procedure did occur at the smaller hospital.

Thank you for your advice. Rebecca

Answer:

Rebecca, TJC stroke certification programs assess the performance at the individual certified site. For purposes of Joint Commission data reporting, abstract the code for the smaller hospital if the procedure was actually done at the smaller hospital going for TSC. If the procedure was actually done at the larger hospital, then they get credit for it. This will be different than how you bill for CMS reimbursement.

Question Details
Focus area(s): Chart Abstracted Measure Specifications – Clinical
Related documents: CSTK, CSTK-08, MER code with combined billing for two hospitals
Manual: Current Manual (current data collection period; prior to data transmission)
File:

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