DOI: 10.1097/01.ASW.0000407656.22242.91
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PMID: 22015747
Issn Print: 1527-7941
Publication Date: 2011/11/01
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Excerpt
Q: What exactly is a CDM?
A: The CDM is a hospital-specific computer file that includes all hospital procedures, services, supplies, drugs, and biologicals that are billed on the paper claim form or its electronic equivalent.
Q: Why is a CDM so important?
A: The CDM is the database from which billing programs capture information to create bills. When wound care professionals itemize their charges (on a charge ticket or on an electronic billing system), the CDM is the database that contains all of the information that is used, by the billing software, to create a bill. To better understand how this file is used, let's look at how the process worked before computers. The wound care professional provided the service/procedure/product to the patient, documented it in the medical record, selected the correct item on the charge sheet, and wrote the number of units provided (if >1 unit was provided). The biller then used the medical record, the charge ticket, and the hospital's master list of charges to create the bill for each patient encounter. Today, that master list of charges is typically the CDM electronic data file. Without the CDM, the hospital could not create bills! If the CDM is not accurate, the wound care department could be overpaid or underpaid; neither situation would be good.
Q: I am a wound care professional. Why is it my job to maintain the CDM for the wound care products and services?
A: CDMs include department-specific information. In fact, one of the first items on the CDM is your department number. The second item on the CDM is typically the charge description number (CDN), which is the number assigned by the business office or accounting department for a specific procedure, service, supply, drug, or biologic provided in your department. Some CDMs may combine the department number and CDN into one number where the department number is the first several digits of the CDN. In that case, the CDM will not include a separate department number.
Because the CDM is department specific, the department personnel are the only hospital wound care experts who know every procedure, service, supply, drug, and biologic that is offered in their department. The department personnel typically provide the following:
Note: Because HCPCS code and CPT code descriptions may be refined from year to year, the department personnel must remember to annually check these code descriptions to ensure that they accurately reflect what is provided and billed.
Note: The product cost is not actually displayed in the CDM. It is used by the finance department to set the hospital charge amount, which is displayed in the CDM and which is used by the billing software to create bills for each patient's encounter.
Q: How should I decide what wound care products, procedures, and services should be included in the CDM?
A: If you want to bill any payer or show any payer the total cost of providing your work, you must include the procedure, service, supply, drug, and biologic in your department's CDM. That is the only way that the item can drop onto the bill.
