Search found 9 matches

by shutchins
Thu Jan 10, 2019 8:59 am
Forum: Medical Auditing Forum
Topic: Time statement- Medical Necessity
Replies: 1
Views: 34

Re: Time statement- Medical Necessity

Whether you are coding the documentation based on time or on the key components, medical necessity is still the overarching criterion. If the provider documents they spent 45 minutes with a patient that presents with a chronic stable problem, the medical necessity still only supports a level three ...
by shutchins
Tue Jan 08, 2019 12:49 pm
Forum: Medical Auditing Forum
Topic: when to use 99451 vs 99446-99449
Replies: 2
Views: 23

Re: when to use 99451 vs 99446-99449

CPT code 99451 was added in 2019 to differentiate between telephone calls and a request that is prepared strictly over the internet or through a shared EMR. While the CPT descriptor includes telephone call, you’ll notice that the term “verbal” is not included with CPT code 99451. Your question has ...
by shutchins
Fri Jan 04, 2019 10:37 am
Forum: Medical Auditing Forum
Topic: Risk Coding
Replies: 1
Views: 54

Re: Risk Coding

In order to bill conditions that risk adjust the documentation must show that the provider assessed the patient on that DOS for that condition. It is not enough for the provider to only list the conditions, this is the reason that a risk adjusted code should not be assigned based on the past histor...
by shutchins
Thu Dec 27, 2018 12:16 pm
Forum: Medical Auditing Forum
Topic: Time Based Billing- Unit/Floor time
Replies: 1
Views: 56

Re: Time Based Billing- Unit/Floor time

In order to bill by time, more than 50% of the encounter needs to focus on counseling/coordination of care. For any typical inpatient service, it is expected that the majority of the visit would be face-to-face at the bedside. Depending on the complexity of the visit, this might be eligible for pro...
by shutchins
Fri Dec 14, 2018 9:02 am
Forum: Medical Auditing Forum
Topic: 2019 E/M Changes
Replies: 1
Views: 101

Re: 2019 E/M Changes

Your question has been answered by Shannon O. DeConda, CPC, CEMC, CEMA, CPMA, CRTT Our stated position is that while this is a tempting offer, prior to adapting your organizations opinion- you should consider the impact. Currently, we are expected to paint a portrait of the patient so that one enco...
by shutchins
Wed Nov 21, 2018 9:50 am
Forum: Medical Auditing Forum
Topic: Wound Vac- Patient owned equipment
Replies: 1
Views: 93

Re: Wound Vac- Patient owned equipment

If the provider is assessing the wound for healing and infection, and / or is irrigating and cleaning the wound, The CPT codes 97605 and 97606 are still billable.
Your question has been answered by J. Paul Spencer, CPC, COC - Senior Compliance Consultant
by shutchins
Fri Nov 16, 2018 11:59 am
Forum: Medical Auditing Forum
Topic: Counting Screening Labs and Imaging in Box B
Replies: 1
Views: 144

Re: Counting Screening Labs and Imaging in Box B

This is credit for the work or ordering or reviewing a lab therefore the reason would not preclude it.
Your Question has been answered by: Shannon O. DeConda, CPC, CEMC, CEMA, CPMA, CRTT
by shutchins
Mon Nov 12, 2018 9:47 am
Forum: Medical Auditing Forum
Topic: Initial Observation less than Detailed History
Replies: 2
Views: 288

Re: Initial Observation less than Detailed History

Since it seems you are an internal coder/auditor- I would actually recommend first you query the provider and ask him to review the documentation to see if all work that was performed has been documented. Keep in mind that providers are human too and mistakes happen. If the provider indicates that ...
by shutchins
Mon Nov 05, 2018 10:52 am
Forum: Medical Auditing Forum
Topic: Preoperative Consult/Clearance
Replies: 2
Views: 222

Re: Preoperative Consult/Clearance

Your question has been answered by NAMAS team member Stephanie Allard: Your second statement of Z01.81- primary is correct. The guidelines state that when a patient is presenting for pre-operative evaluations only the code from category Z01.81- would be sequenced primary. https://www.cms.gov/Medicar...