Search found 447 matches

by admin
Wed Oct 17, 2018 10:54 am
Forum: Medical Auditing Forum
Topic: Endocrinology HPI and Exam
Replies: 4
Views: 815

Re: Endocrinology HPI and Exam

Without a clear date and time, the vitals documented in the second half of the question below can’t be credited. If there is a date and time, this counts as a Constitutional system under 1995 guidelines, or as one bullet under 1997. For 1997, this would qualify as the status of three chronic conditi...
by admin
Wed Oct 17, 2018 10:07 am
Forum: Medical Auditing Forum
Topic: Student catches baby during delivery
Replies: 1
Views: 539

Re: Student catches baby during delivery

Usually in the delivery room, the physician is in attendance, but a delivery nurse does the bulk of the work. As long as the physician is in the room, and upon delivery, works with the maternity team to stabilize the newborn postpartum, the delivery charge can be billed. Who caught the baby doesn’t ...
by admin
Wed Oct 10, 2018 9:29 am
Forum: Medical Auditing Forum
Topic: Auditing CAPD
Replies: 2
Views: 626

Re: Auditing CAPD

Good morning, I am most positive that we have not dealt with that specific service. I would encourage you to research any CPT Assistant article that might provide insight into the code specific guidance. However, please note that the code you mentioned is an unlisted procedure code and while they sh...
by admin
Mon Oct 08, 2018 8:08 am
Forum: Medical Auditing Forum
Topic: Co-surgeon 2 specialty requirement
Replies: 1
Views: 632

Re: Co-surgeon 2 specialty requirement

Good morning, It is possible some payers will not follow the guidance from CMS, but my experience with the major ones is they do. You will have to search your individual payer policies to know for sure. This may be as simple as a quick google search. For example, I googled BCBS co surgeon and the fi...
by admin
Thu Oct 04, 2018 1:59 pm
Forum: Medical Auditing Forum
Topic: Minimal sedation with E/M service
Replies: 1
Views: 492

Re: Minimal sedation with E/M service

Minimal sedation is included in the E/M services as it is done using medication, that does not require extensive independent monitoring, or injection services. Since it is not a separately billable service, and does not require independent monitoring, it does not have to be excluded when documentati...
by admin
Wed Sep 26, 2018 1:30 pm
Forum: Medical Auditing Forum
Topic: Prolonged Care same day as procedure
Replies: 1
Views: 581

Re: Prolonged Care same day as procedure

Each separately billable service is not part of the time for prolonged services. If the time documentation criteria is met then it would be ok. I have seen it, but the documentation needs to specifically exclude every other service that would be affecting the overall level of time. By "specifically"...
by admin
Thu Sep 20, 2018 11:30 am
Forum: Medical Auditing Forum
Topic: EPF Detailed Exam- Noridian Jurisdiction F
Replies: 1
Views: 487

Re: EPF Detailed Exam- Noridian Jurisdiction F

Hello, Based on the 95 guidelines, both EPF and detailed exams are documentation of 2-7 organ systems. The difference is a detailed exam also requires more detail in the exam of the affected organ system. This is usually 3-4 findings documented. If you are unclear about what an appropriate finding i...
by admin
Wed Sep 05, 2018 2:59 pm
Forum: Medical Auditing Forum
Topic: HPI
Replies: 1
Views: 485

Re: HPI

Hi there! The HER-2 negative further explains the diagnosis of breast cancer so that could only be counted as one point.

Your question has been answered by Stephanie Allard, CPC, CEMA, RHIT
by admin
Tue Sep 04, 2018 8:55 am
Forum: Medical Auditing Forum
Topic: Data Points for ordering imaging for NG tube placement
Replies: 1
Views: 551

Re: Data Points for ordering imaging for NG tube placement

Hi there,

This is absolutely correct., Review and/or order of radiological tests counts as a category of data.

Your question has been answered by J. Paul Spencer, CPC, COC
by admin
Tue Sep 04, 2018 8:08 am
Forum: Medical Auditing Forum
Topic: 3 chronic conditions
Replies: 1
Views: 546

Re: 3 chronic conditions

Hello, If you want to take credit for it, then it should be in the history of present illness. The guidelines state within the HPI for 95/97 for extended HPI 4+ elements or the status of 3 chronic conditions. Since the guidelines are listed in this section this is where they would expect to find the...