Search found 11 matches

by Bill_Wong
Wed Dec 05, 2018 5:25 pm
Forum: Medical Auditing Forum
Topic: Initial Observation less than Detailed History
Replies: 2
Views: 725

Re: Initial Observation less than Detailed History

Working in a compliance department, we always give the direction of not billing at all. If the intent of the note does not reflect the CPT coded, we advise against billing another code. In your case, if the intent is Observation, but the notes does not support any of the observation codes, it should...
by Bill_Wong
Wed May 23, 2018 5:07 pm
Forum: Medical Auditing Forum
Topic: MDM - data points for general statement?
Replies: 2
Views: 697

Re: MDM - data points for general statement?

Hi Perri, I would need to look at the complete documentation to see if the assigned MDM is supported. Some items that I would look for are: 1. Time stamp that the labs, radiographs, etc were indeed reviewed by provider; and/or 2. If the results of labs, radiographs, etc were pulled into provider rep...
by Bill_Wong
Tue May 22, 2018 4:33 pm
Forum: Medical Auditing Forum
Topic: 15734- muscle flap
Replies: 2
Views: 725

Re: 15734- muscle flap

Hi Debben, I am not a Thoracic Surgery coder and/or auditor, so forgive me if I do not understand the surgery accurately. Here are my thoughts (without looking at the sugery note): If we are covering the internal structures of the body,i.e, esophagus, with a muscle flap, I would not use the CPT code...
by Bill_Wong
Thu May 17, 2018 6:19 pm
Forum: Medical Compliance Forum
Topic: Xray billed
Replies: 2
Views: 1951

Re: Xray billed

Hi brownlee47, Personally, I think it should NOT be billed. IF a provider is doing something Pro-bono, that part of the service should not be billed just because no one is billing that services to any payer. I see this similar to donated medical products and samples from medical companies. Having sa...
by Bill_Wong
Tue May 15, 2018 4:33 pm
Forum: Medical Auditing Forum
Topic: Billing Laboratory test with Inconclusive/Invalid test resul
Replies: 2
Views: 827

Re: Billing Laboratory test with Inconclusive/Invalid test r

Hi FJohnson, I would question why you would not re-run the original test if you have inconclusive results. You could possibly be setting yourself up for legal medical care issues if the provider is making decisions based on faulty data. For example, if you suspect a fracture and the original radiogr...
by Bill_Wong
Tue May 15, 2018 4:10 pm
Forum: Medical Auditing Forum
Topic: Coding Ultrasound services
Replies: 1
Views: 491

Re: Coding Ultrasound services

Hi FJohnson, This excerpt may apply to your situation. Taken from Medicare Benefit Policy Manual, Ch. 15: 80.6.4 - Rules for Testing Facility Interpreting Physician to Furnish Different or Additional Tests (Rev. 80; Issued: 11-11-08; Effective: 01-01-03; Implementation: 11-19-07) The following appli...
by Bill_Wong
Fri Apr 13, 2018 1:31 pm
Forum: Medical Auditing Forum
Topic: Well Visit plus breast mass/MDM Question
Replies: 2
Views: 873

Re: Well Visit plus breast mass/MDM Question

Hi Alexis, Why would you use Z01.419 - Encounter for gynecological examination (general) (routine) without abnormal findings? Since the provider HAD some abnormal finding, another lump, wouldn't you use Z01.411 - Encounter for gynecological examination (general) (routine) with abnormal findings? Wit...
by Bill_Wong
Fri Apr 13, 2018 12:48 pm
Forum: Medical Auditing Forum
Topic: Can a patients spoken language count for Social Hx?
Replies: 2
Views: 953

Re: Can a patients spoken language count for Social Hx?

I agree with Pam. It should not be counted.

However, if it was documented that she is also a foreign language instructor, you can listed this as Social History as "Current employment."
by Bill_Wong
Fri Apr 13, 2018 12:41 pm
Forum: Medical Auditing Forum
Topic: Outpatient procedure/discharge next day
Replies: 1
Views: 608

Re: Outpatient procedure/discharge next day

Hi Stephb13, I am not following your scenario. Are you saying that a patient came to the hospital to get a CT guided needle biopsy. There were no complications, yet was in the hospital for 28 hours. A D/C was charged. Are you asking if an outpatient E/M be charged? if that is the case, I would say "...
by Bill_Wong
Fri Apr 13, 2018 12:21 pm
Forum: Medical Compliance Forum
Topic: New versus Established and Change of Tax ID#
Replies: 2
Views: 2703

Re: New versus Established and Change of Tax ID#

Hi Charlene, It will be considered established patient, if the patient comes within the 3 years time frame. Here is a Q/A from Noridian. See "Claim Examples 2." A patient sees Dr. Smith, a cardiologist, for follow up care at "Clinic A." Date of Service Service Provided CPT Code 06/23/17 Established ...