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Title: Section 444.20 - Ancillary services expenses description

444.20 Ancillary services expenses description. (3270)

(a) 7010 LABOR AND DELIVERY SERVICES (1) Function. Labor and Delivery services are provided by specially trained personnel to patients in Labor and Delivery, including prenatal care in labor, assistance in delivery, postnatal care in recovery, and minor gynecological procedures, if performed in the Delivery suite. Additional activities include, but are not limited to, the following:

Comforting patients in the labor and delivery and recovery rooms; maintaining aseptic techniques; preparing for deliveries and surgery; cleaning up after deliveries to the extent of preparation for pickup and disposal of used linen, gloves, instruments, utensils, equipment and waste; arranging sterile setup for deliveries and surgery; preparing patient for transportation to delivery room and recovery room; enforcing of safety rules and standards; monitoring of patients while in recovery.

(2) Description. This cost center contains the direct expenses incurred in providing care to maternity patients in labor, delivery, and recovery rooms. Included as direct expenses are: salaries and wages, employee benefits, supplies, purchased services, other direct expenses, and transfers.

(3) Standard Unit of Measure: number of procedures. Report multiple births as one procedure. Include Caesarean sections only when they are performed in delivery room. Caesarean sections performed in the Surgical suite shall be included in the operating room statistics. Stillbirths are counted as procedures. Infants born outside the hospital building are not to be classified as a procedure unless care was rendered in the Labor and Delivery Services. Whenever obstetrical and gynecological procedures such as abortions, D & C's, etc. are performed in Labor and Delivery, each procedure performed is counted as one.

(4) Data source. The number of procedures shall be an actual count obtained from medical records, or as maintained by Labor and Delivery.

(b) Surgical Services Group.

(1) 7040 SURGERY SERVICES

7041 General Surgery

7042 Open Heart Surgery

7043 Neurosurgery

7044 Orthopedic Surgery

7045 Kidney Transplant

7046 Other Organ Transplants

7049 Other Operating Room Services

(i) Function. Surgical Services are provided to inpatients, and outpatients if the hospital uses a common operating room for both inpatients and outpatients, by physicians and specially trained nursing personnel who assist physicians in the performance of surgical and related procedures during and immediately following surgery. Additional activities include, but are not limited to, the following:

Comforting patients in the operating room; maintaining aseptic techniques; scheduling operations in conjunction with surgeons; assisting surgeon during operations; preparing for operations; cleaning up after operations to the extent of preparation for pickup and disposal of used linen, gloves, instruments, utensils, equipment and waste; assisting in preparing patients for surgery; inspecting, testing and maintaining special equipment related to this function; preparing patient for transportation to recovery room; counting of sponges, needles and instruments used during operation; enforcing of safety rules and standards.

(ii) Description. These cost centers contain the direct expenses incurred in providing surgical services to patients. When a common operating room is used for both inpatients and outpatients, the direct costs for both are to remain in this cost center. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: number of surgery minutes.Surgery minutes is the difference between starting time and ending time, defined as follows:

Starting time is the beginning of anesthesia administered in the room in which the procedure is to be performed (or surgery if anesthesia is not administered or if anesthesia is not administered in the operating room). Ending time is the end of surgery.

(iv) Data source. The number of surgery minutes shall be an actual count obtained from the operating room log.

(2) 7060 RECOVERY SERVICES (i) Function. Recovery Services are provided by specially trained personnel immediately following surgery, including monitoring of patients while recovering from anesthesia. Additional activities include, but are not limited to, the following:

Comforting patients in the recovery room, maintaining aseptic techniques, monitoring of vital life signs, operating of specialized equipment related to this function, administering specified medication, observing patient's condition until all effects of the anesthesia have passed, preparing patient for transportation to acute care or intensive care units. (ii) Description.This cost center contains the direct expenses incurred in monitoring of patients while recovering from anesthesia. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: number of recovery room minutes. Recovery room minutes is the difference between time of admission to recovery room and time of discharge from the unit.

(iv) Data source. The number of recovery room minutes shall be an actual count maintained by the recovery room.

(3) 7080 ANESTHESIOLOGY (i) Function. Anesthesia services are rendered in the hospital by, or under the direction of, either a physician trained in anesthesia or the operating surgeon. Additional activities include, but are not limited to, the following:

Recording kind and amount of anesthetic administered; conducting physical examination of patients; observing patient's condition until all effects of the anesthesia have passed; obtaining laboratory findings before anesthetic is administered; administering treatment to patients having symptoms of post-anesthetic complication; accompanying patient to recovery room or Intensive care unit; prescribing pre- and post-anesthesia medication; establishing and carrying out safeguards for administration of anesthetics.

(ii) Description. This cost center contains the direct expenses incurred in administering anesthetics under the direction of a physician. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: number of anesthesia minutes.Anesthesia time begins when the anesthesiologist begins to prepare the patient for the induction of anesthesia in the operating room or in an equivalent area, and ends when the anesthesiologist is no longer in personal attendance, that Is, when the patient may be placed under post-operative supervision.

(iv) Data source. The number of anesthesia minutes shall be an actual count maintained by the Anesthesiology cost center.

(c) Medical Supplies and Equipment Group.

(1) 7110 MEDICAL SUPPLIES SOLD (i) Description. The Medical Supplies Sold cost center is used for the accumulation of the invoice cost of all medical and surgical supplies sold directly to patients. The invoice/inventory cost of non-chargeable supplies and equipment issued by the Central Services and Supplies cost center (Account 8460) to other cost centers shall be reported in the using cost centers. If medical and surgical supplies are sold in other hospital cost centers, the cost of those items must be reported in to this cost center. The overhead cost of preparing and issuing medical and surgical supplies and equipment sold directly to patients must be reported in the Central Services and Supplies cost center (account 8460). The applicable portion of such overhead will be allocated to this cost center during the cost allocation process. The cost of reusable patient chargeable supplies must be reported in the Central Services and Supplies cost center. Do not report in this cost center the cost of durable medical equipment sold, leased or rented. Such costs are to be reported in accounts 7130 and 7140, Durable Medical Equipment--Sold, and Durable Medical Equipment--Leased/Rented, respectively.

(ii) Standard unit of measure: none required; not applicable.

(iii) Effective date. Relative to the separation of Durable Medical Equipment (accounts 7130 and 7140) from this cost center, the effective date is cost reporting periods beginning in 1982 and thereafter.

(2) 7130 DURABLE MEDICAL EQUIPMENT--SOLD

(i) Description. The Durable Medical Equipment--Sold cost center is used to report the invoice/inventory costs of all durable medical equipment sold directly to patients. Durable Medical Equipment includes but is not limited to: hospital beds, wheelchairs, trapeze bars, oxygen tents, intermittent positive breathing machines, etc. Include in the appropriate Home Program Dialysis cost center the cost of dialysis and supportive equipment sold. The overhead cost of preparing and issuing durable medical equipment sold directly to patients and others must be reported in the Central Services and Supplies cost center (account 8460).

(ii) Standard unit of measure; none required; not applicable.

(iii) Effective date. Reporting periods beginning in 1982 and thereafter.

(3) 7140 DURABLE MEDICAL EQUIPMENT--LEASED/RENTED

(i) Description. The Durable Medical Equipment--Leased/Rented cost center is used to report depreciation expenses related to the Durable medical equipment leased or rented directly to patients and others. Durable medical equipment includes but is not limited to: hospital beds, wheelchairs, trapeze bars, crutches, canes, oxygen tents, intermittent positive breathing machines, exercycles, heat lamps, flotation mattresses, bed baths, etc. Include home program dialysis equipment and support in the appropriate Home Program Dialysis cost center. The overhead cost of preparing and issuing durable medical equipment leased and rented to patients and others must be reported in the Central Services and Supplies cost center (account 8460). (ii) Standard Unit of Measure; none required; not applicable.

(iii) Effective date. Reporting periods beginning in 1982 and thereafter.

(d) 7150 DRUGS SOLD (1) Description. The Drugs Sold cost center is used for the accumulation of the invoice/inventory cost of all pharmaceuticals, intravenous solutions and blood derivatives sold directly to patients. The invoice/inventory cost of non-chargeable drugs (pharmaceuticals, blood derivatives and I.V. solutions) issued by the Pharmacy (account 8470) to other cost centers shall be reported in the using cost centers. If such items are sold in other cost centers, the cost of those items must be transferred to this cost center. The overhead cost of preparing and issuing drugs sold directly to patients must be accumulated in the Pharmacy cost center (account 8470). The applicable portion of such overhead will be allocated to this cost center during the cost allocation process.

(2) Standard Unit of Measure: none required; not applicable.

(e) Laboratory Services Group.

(1) 7210 LABORATORY SERVICES-CLINICAL

7211 Chemistry

7212 Hematology

7213 Immunology (Serology)

7214 Microbiology (Bacteriology)

7215 Procurement and Dispatch

7216 Urine and Feces

7219 Other Clinical Laboratories

(i) Function. These cost centers perform diagnostic and routine clinical laboratory tests necessary for the diagnosis and treatment of hospital patients. Additional activities include, but are not limited to, the following:

Transporting specimens from nursing floors and operating rooms; drawing of blood samples; caring for laboratory animals and equipment; maintaining quality control.

(ii) Description. These cost centers contain the direct expenses incurred in the performance of laboratory tests necessary for diagnosis and treatment. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: workload measurement units. Laboratory Workload Recording Method, published by College of American Pathologists (use the latest edition). In recording Workload Measurement Units, workload units related to quality control standards, calibration standards and specimen collection, duplicates and repeats for which a patient is not charged are not to be counted. Workload units for unlisted procedures should be reasonably estimated based upon work units for other comparable procedures, or estimated by qualified personnel. Workload measurement units shall be maintained and reported for laboratory services obtained from outside laboratories.

(iv) Data source. The number of workload measurement units shall be an actual count maintained by the laboratory.

(2) 7230 LABORATORY SERVICES-PATHOLOGICAL

7231 Cytology

7232 Histology

7233 Autopsy

7239 Other Pathological Laboratories

(i) Function. These cost centers perform diagnostic and routine laboratory tests on tissues and cultures necessary for the diagnosis and treatment of hospital patients. Additional activities include, but are not limited to, the following:

Mortuary operation, autopsy; transportation of specimens from nursing floors and operating rooms; care of laboratory animals and equipment; maintenance of quality control standards; preparation of samples for testing.

(ii) Description. These cost centers contain the direct expenses incurred in the performance of diagnostic and routine tests on tissues and cultures. included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: workload measurement units. Laboratory Workload Recording Method, published by College of American Pathologists (use the latest edition). In recording Workload Measurement Units, workload units related to quality control studies, calibration standards and specimen collection, and repeats for which a patient is not charged, are not to be counted. Workload units for unlisted procedures should be reasonably estimated based upon work units for other comparable procedures, or estimated by qualified personnel. Workload measurement units shall be maintained and reported for laboratory services obtained from outs ide laboratories.

(iv) Data source. The number of workload measurement units shall be an actual count maintained by the laboratory.

(3) 7250 WHOLE BLOOD AND PACKED RED CELLS (i) Function. This cost center procures and collects whole blood and packed red cells. Also included in the recruitment of donors.

(ii) Description. This cost center contains the direct expense incurred in procuring whole blood and packed red cells, drawing blood and recruiting and paying donors. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services and other direct expenses. Do not include in this cost center the expenses incurred in performing tests on blood (i.e., typing, crossmatching, etc.). These expenses must be reported in Laboratory Services--Clinical (account 7210). The cost of blood derivatives is to be reported in account 7150, Drugs Sold (if the patient is charged), or the using cost center (if the patient is not charged). The cost of blood (amount paid or fair market value) is reported in this cost center, or an inventory account if applicable, rather than netted against revenue or cleared through an agency account. When blood is purchased, cost is the amount paid. The service fee charged by the outside blood sources is not reported here but reported in Blood Processing and Storing (account 8480). When blood is donated, cost is its fair market value at the date of donation and an offsetting amount is reported in Donated Blood (account 5770).

If replacement blood is received by the hospital blood bank, the original amount charged the patient is reported in this cost center and removed from the patient's account (Accounts and Notes Receivable, account 1030).

(iii) Standard Unit of Measure: workload measurement units. Laboratory Workload Recording Method, published by College of American Pathologists (use the latest edition).

(iv) Data Source. The number of workload measurement units shall be an actual count maintained by this cost center.

(4) 7260 BLOOD PROCESSING AND STORING (i) Function. This cost center processes, preserves, stores, and issues whole blood and packed red cells after it has been procured. Additional activities include, but are not limited to, the following:

Plasma fractionation; freezing and thawing blood; maintaining inventory control.

(ii) Description. This cost center contains the direct expenses incurred in processing, storing, and issuing whole blood and packed red cells after it has been procured. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services and other direct expenses. Include in this cost center the cost of spoiled or defective blood, and the service fee charged by outside blood sources, whether or not the blood is replaced. Do not include in this cost center the expenses incurred in performing tests on blood (i.e., typing, cross-matching, etc.). These expenses must be reported in Laboratory Services--Clinical (account 7210). `The cost of blood and packed red cells must be reported in the Whole Blood and Packed Red Cells cost center (account 7250). The cost of blood derivatives must be in the Drugs Sold cost center (account 7250) if the patient is charged, or the using cost center if the patient is not charged.

(iii) Standard Unit of Measure: workload measurement units. Laboratory Workload Recording Method, published by College of American Pathologists (use the latest edition).

(iv) Data source. The number of workload measurement units shall be an actual count maintained by this cost center.

(f) 7290 ELECTROCARDIOGRAPHY (1) Function. This cost center operates specialized equipment to record graphically electromotive variations in actions of the heart muscle; record graphically the direction and magnitude of the electrical forces of the heart's action; and/or record graphically the sounds of the heart for diagnostic purposes. Additional activities include, but are not limited to, the following:

Wheeling portable equipment to patients' bedside; explaining test procedures to patient; operating specialized equipment; inspecting, testing and maintaining special equipment; attaching and removing electrodes from patient.

(2) Description. This cost center contains the direct expenses incurred in performing electrocardiographic examinations. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(3) Standard Unit of Measure: workload measurement units. Laboratory Workload Recording Method, published by College of American Pathologists (use the latest edition). Workload units for unlisted procedures should be reasonably estimated based upon work units for other comparable procedures, or estimated by qualified personnel.

(4) Data source. The number of workload measurement units shall be an actual count maintained by this cost center.

(g) 7310 CARDIAC CATHETERIZATION LABORATORY (1) Function. The Cardiac Catheterization Laboratory provides special diagnostic procedures such as catheterization required for care of patients with cardiac conditions.

(2) Description. This cost center shall contain the direct expenses incurred in providing cardiac catheterization diagnostic examinations. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers.

(3) Standard Unit of Measure: number of procedures. Count each cardiac catheterization procedure for which a charge is made as one procedure.

(4) Data source. The number of procedures shall be the actual count maintained by the Cardiac Catheterization Laboratory. (h) Radiology Services Group.

(1) 7320 RADIOLOGY--DIAGNOSTIC

7321 Angiocardiography

7322 Ultrasonography

7339 Radiology--Diagnostic--Other

(i) Function. This cost center provides diagnostic radiology services as required for the examination and care of patients under the direction of a qualified radiologist. Diagnostic radiology services include the taking, processing, examining and interpreting of radiography, ultrasonograms, and fluorographs. Additional activities include, but are not limited to, the following:

Consultation with patients and attending physician; radioactive waste disposal; storage of radioactive materials.

(ii) Description. This cost center contains the direct expenses incurred in providing diagnostic radiology services. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies. purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: relative value units. Radiology Relative Values as determined by the California Medical Association, 1974 California Relative Value Studies. Relative value units for unlisted and "BR" (By Report) procedures should be reasonably estimated on the basis of other comparable procedures or estimated by qualified personnel. (Count "Total Unit Value", not "PC Unit Value".)

(iv) Data source. The number of relative value units shall be the actual count maintained by the Radiology--Diagnostic cost center.

(2) 7340 CT SCANNER (i) Function. The CT (computed tomographic) Scanner function provides computed tomographic scans of the head and other parts of the body.

(ii) Description. This cost center shall contain the direct expenses incurred in providing CT scans. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: number of procedures. Count each computed tomographic scanner procedure as one procedure. Count only those procedures which are charged for. A patient procedure is defined as the initial scan and any additional scans of the same anatomical area during a single visit.

(iv) Data source. The number of procedures shall be the actual count maintained by the CT Scanner cost center.

(3) 7360 RADIOLOGY--THERAPEUTIC (i) Function. This cost center provides therapeutic radiology services as required for the care and treatment of patients under the direction of a qualified radiologist. Therapeutic radiology services include therapy by radium and radioactive substances. Additional activities include, but are not limited to, the following:

Consultation with patients and attending physician; radioactive waste disposal; storage of radioactive materials.

(ii) Description. This cost center contains the direct expenses incurred in providing therapeutic radiology services. Included in these direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: relative value units. Radiology Relative Values as determined by the California Medical Association, 1974 California Relative Values Studies. Relative value units for unlisted and "BR" (By Report) procedures should be reasonably estimated on the basis of other comparable procedures or estimates by qualified personnel. (Count "Total Unit Value", not "PC Unit Value".)

(iv) Data source. The number of relative value units shall be the actual count maintained by the Radiology--Therapeutic cost center.

(4) 7380 NUCLEAR MEDICINE

7381 Nuclear Medicine--Diagnostic

7382 Nuclear Medicine--Therapeutic

(i) Function. This cost center provides diagnosis and treatment

Volume

VOLUME C (Title 10)

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