NAMAS Webinar Q&A: Hands On Auditing: 2020 vs 2021, 11/23/2020

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Below are the questions received during our recent webinar, Hands On Auditing: 2020 vs 2021, originally presented on November 23, 2020. These questions have been answered by the webinar presenter, Brenda Edwards, CPC, CDEO, CPB, CPMA, CPC-I, CEMC, CRC, CPMS, CMCS, CMRS

Question 1:
You mentioned credit is NOW given for Rx drug management WITHOUT a change to the Rx (Rx change: start, stop, increase, decrease no longer required for credit). Example #Hypothyroidism-Synthroid = Rx drug management.
Answer 1:
I don’t believe I indicated that and if I did I apologize. PDM includes initiation, continuation, modification or discontinuation of a prescription drug.

Question 2:
-Rx drug management only applies when the condition linked to the Rx was addressed during the visit, correct?
Answer 2:
PDM that has supporting documentation of the condition being treated at that encounter.

Question 3:
-Whereas, credit for Rx drug management would not apply when say CC: cough - only cough was addressed (no Rx) but the provider documented a condition which the patient takes a Rx for that was NOT addressed or impacting care that visit for example #leg pain-gabapentin (no other details in the note)?
Answer 3:
Agree since there is a mention of a medication without how it could impact the current condition.

Question 4:
-Reviewing the medication list that only contains prescriptions for conditions NOT addressed or affecting care that visit does not count as Rx drug management, correct?
Answer 4:
Correct, a simple review of a medication list without including what the medications are taken for, how they are responding, etc. would not be sufficient.

Question 5:
You mentioned EKGs. If we bill for EKG tracing (93005) and another speciality bills for the EKG interpretation (93010) can we get credit for independent interpretation of EKG since we are only billing the technical portion? -We would not get credit for ordering the EKG even though we are only billing for the tracing/technical portion
Answer 5:
You get credit for ordering or reviewing but if another specialty is interpreting it, you could not count that too.

Question 6:
You mentioned UTI as an example when choosing between 'acute, uncomplicated illness' & 'acute illness with systemic symptoms'.
If the only symptoms are dysuria, urgency and increase frequency this would not be considered UTI w/systemic symptoms because all those symptoms are part of the GU system, even if fever/ body aches as well, still would not be considered systemic since those fall under constitutional/general system, correct?
Answer 6:

Question 7:
To count as 'acute illness with systemic symptoms' is there a minimum number of systems (on the ROS list) the symptoms must fall under to be considered an 'acute illness with systemic symptoms'?
Answer 7:
No, ROS no longer is counted and the current guidelines do not indicated anything like that.

Question 8:
Excluding constitutional system a.k.a general (as those symptoms are applicable to S/L-minor or acute,uncomplicated illness) and the conditions' system itself in this case excluding GU system since the condition is UTI?
Answer 8:
The systemic symptoms may or may not be related to a single system so I would not exclude GU from it.

Question 9:
-If you’re billing the CPT, you cannot get credit for ordering?
-If you’re billing the CPT, you cannot get credit for reviewing?
Answer 9:
Correct, if the provider is billing a separately identifiable service with a CPT code, you do not count it in the EM determination because the provider is already being compensated for it.

Question 10:
-If you’re not billing the CPT, you can get credit for ordering?
-If you’re not billing the CPT, you can get credit for reviewing, but only if you did not order it (whether you reviewed same visit or next visit- you can never get credit for reviewing a test you ordered)?
Answer 10:
Correct otherwise it would be counted as double dipping

Question 11:
-If you’re not billing CPT, you can get credit for both ordering & reviewing same visit if the order & review are for different tests & the test reviewed was not ordered by you?
Answer 11:
You are correct!
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