Download UCSF Medical Center Clinical Trial Chargeable Procedure

UCSF Medical Center
Clinical Trial Chargeable Procedure Guidelines for Clinical Research Coordinators
This tool tip will provide the Clinical Research Coordinators (CRC) assistance for completing
key information for the Chargeable Procedure Code Table on the Clinical Research Study Form.
Let’s start with some basic definitions that are important to understand in your role.
CPT = Current Procedural Terminology established by the American Medical
Association(AMA) is a listing of descriptive terms and identifying codes for reporting medical
services and procedures. CPT codes are generated through the American Medical Association
(AMA) and remain constant throughout UCSF and other healthcare institutions.
Evaluation and Management (E&M) is a medical billing process that are based on the CPT
codes that practicing physicians follow in order for reimbursements by Medicare, Medi-Cal, or
other private insurance companies for patient encounters (inpatient/outpatient visits)
EAP = Name of the APeX master file where procedures are located for UCSF’s electronic
medical record. Procedures are those items that are Ordered, Performed, and Chargeable
(Billable).
Inpatients are registered as inpatient in APeX and assigned to a bed and nursing floor and spend
a minimum of one night in the hospital.
Outpatients are registered as outpatient in APeX and not assigned a bed overnight. These
patients could receive services in Outpatient Clinics or Surgery Center (same day surgery).
The CRC will need to identify the hospital services, procedures, or medications that are
required within your given research study protocol. Depending on what type of service,
procedure, or medication you need to order for a research study participant, there may be
any number of charges associated: Hospital charges, Professional fees, and/or Facility fees.
For example, if you order an X-ray, there will be a “hospital charge” for obtaining the image as
well as a “professional fee” for the radiologist who will interpret the image. There may be
scenarios where your study PI will be the physician rendering the study services, in which case
the professional fee may or may not be billable to the research study grant.
In order to help you as the CRC assess the associated charges with your research study
procedures, and the research rate at which the charges will be applied to your study grant,
consider these questions below:
1. Do you have the CPT code and/or EAP (Hospital and/or Pro Fee chargeable) number of the
service, procedure, drug or the supply for which you need a research rate (note: the Pro Fee
chargeable equals the CPT code and the Hospital Chargeable is an 8-digit number)?
2. If not, do you know who to contact in the performing department where the services are
performed that can provide the CPT and EAP numbers that will be charged to the grant?
3. Are the study participants to be inpatient or outpatient?
4. If outpatient, where will the services be performed? Clinic? Medical Center Ancillary
Department? Ambulatory Surgery Center? O.R.? Can be multiple areas and departments.
5. Do you need the pro fees associated with the procedure (if any)? Is the physician rendering
the service the Primary Investigator or receiving a percent effort? If so, then the pro fees are
generally not billable to the grant.
UCSF Medical Center
Clinical Trial Chargeable Procedure Guidelines for Clinical Research Coordinators
For example most Radiology procedures will have both a hospital and professional fee
charged to the research grant. Also, office visits (Evaluation and Management Services) will
be charged both a professional fee and a facility fee.