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Chargemaster Basics: Your Guide to Healthcare Pricing and Coding

Discover the essential elements of a Chargemaster (CDM), from charge codes to CPT/HCPCS codes, and how it impacts billing, claims processing, and regulatory compliance. Learn why CPT/HCPCS codes are crucial and how to update the Chargemaster effectively.

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Chargemaster Basics: Your Guide to Healthcare Pricing and Coding

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  1. Charge Master Description

  2. Chargemaster Basics What is a Chargemaster (CDM)? Charge Description Master • Menu of all services provided by the facility, usually listed by department

  3. Common information makes up the Chargemaster • Department# • Charge Code number (7 digits) • Description • Price • CPT/HCPCS Code • Revenue Code

  4. CPT/HCPCS • C urrent • P rocedural • T erminology Level I - CPT Level II - HCPCS • Describe physician procedures and certain hospital outpatient services. Example - “93005” EKG procedure • H ealthcare • C ommon • P rocedure • C oding • S ystem • Supplement CPT codes Example “J0560” Benadryl

  5. Claims processing Payment reimbursement Regulatory requirements Why use CPT/HCPCS Codes?

  6. Department Chargemaster Sample

  7. UB 92 • The UB92 is the bill that is sent to the third party payers. • The UB92 claim form contains 86 field locators.

  8. Hospital Charge Addition Process Web site for adding charges Add new charge, change, inactivation Double click Transferred to hospital finance email address MCG Healthcare Policy Turn around time = 10 work daysNo back dating Charge calculated

  9. When to Update the CDM • Annual coding changes (Oct. thru Dec.) • Changes in CMS reimbursement guidelines • Changes in technology • New department services • New product lines

  10. Questions?

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