News You Can Use: State Medicaid Programs Offer E/M, Vaccine Reimbursement Boosts

Posted on 08. May, 2013 by rpandit.

Watch for retroactive pay raises, if you self-attest.
Getting a payment increase from Medicaid sounds quite appealing to most practices, and it can be a reality for some primary care providers — but don’t forget to do your part to ensure that you’ll see a rise in Medicaid payments for E/M and vaccine services this year. Follow a few quick steps to confirm that you’ll get the raise.

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Reader Question: Watch Details When Deciding Between Levels 4 and 5 E/M

Posted on 24. Apr, 2013 by rpandit.

Question: We have enough details for an encounter to reach these levels: 

·         HPI – detailed

·         ROS – complete

·         PFSH – complete

·         EXAM – 10 systems

·         MDM – moderate.

Is this documentation sufficient to support a Level 5 E/M code for an established patient?

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CPT 2011 Begs CMS Reexamination of Time as Averages or Thresholds

Posted on 14. Nov, 2010 by jennifer.godreau.

All that fine green print on time in your E/M CPT 2011 manual boils down to one thing: you can round to the closest time code.

But that advice from CPT contradicts Medicare’s threshold time guideline.

CPT Treats Times as Averages

 CPT 2011 indicates you can use the code closest to the documented time. That advice is nothing new. “In selecting time, the physician must have spent a time closest to the code selected,” states

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E/M Coding Makes OIG 2011 Work Plan

Posted on 21. Oct, 2010 by jennifer.godreau.

Make sure your postop office visit documentation measures up.

The OIG has once again set its sights on several new targets to go with the upcoming new year, and this time the feds will be double- and triple-checking your E/M documentation.

On Oct. 1, the OIG published its 2011 Work Plan, which outlines the areas that the Office of Audit Services, Office of Evaluations and Inspections, Office of Investigations, Office of Counsel to the Inspector General, Office of Management  and Policy, and Immediate Office of the Inspector General will address during the 2011 fiscal year. When the OIG targets an issue in its Work Plan, you can expect the agency to carefully review and audit sample claims of those services.

The Work Plan “describes the specific audits and evaluations that we have underway or plan to initiate in the year ahead considering our discretionary and statutorily mandated resources,” the document indicates.

On the agenda for next year, the OIG has indicated that its investigators will “review the extent of potentially inappropriate payments for E/M services and the consistency of E/M medical review determinations.” The OIG also plans to hone in on whether payments

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History of Present Illness Must Be Taken by MD, NPP

Posted on 16. Sep, 2010 by jennifer.godreau.

Don’t let nurses do the doctor’s work, or risk downcoded E/Ms upon audit.

The only parts of the E/M visit that an RN can document independently are the Review of Systems (ROS), Past, Family, and Social History (PFSH) and Vital Signs, according to a June 4, 2010 Frequently Asked Questions (FAQ) answer from Palmetto GBA, Part B carrier for Ohio. The physician or mid-level provider must review those three areas and write a statement that the documentation is correct or add to it.

Only the physician or non-physician practitioner who conducts the E/M service can perform the History of Present Illness (HPI),  Palmetto says.

Exception: In some cases, an office or Emergency Department triage nurse can document “pertinent information” regarding the Chief Complaint or HPI, Palmetto says. But you should treat those notes as

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Use 3 CPT, Modifier, and ICD-9 Code Pairs to Ace This X-Ray Claim

Posted on 24. May, 2010 by Editor.

Decipher why you should include a seconding diagnosis.

Question: A 38-year-old patient presents to the emergency room with complaints of wheezing, coughing, and trouble catching her breath. After the nonphysician practitioner (NPP) performs a problem-focused history, the physician performs a detailed history and exam and discovers focal ronchi. The physician orders a two-view chest x-ray to check for upper respiratory infection (URI) The chest x-ray results reveal acute URI, and the ronchi clears up upon reevaluation. The patient is treated with antibiotics. How should I code this scenario?

Answer:

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Ensure Counseling Claims With Pointed Questions

Posted on 09. May, 2010 by Editor.

This modifier is key to E&M and counseling codes cohabiting on your claim.

Question: Can I report alcohol cessation counseling codes along with E/M codes, or do I have to choose one or the other?

Idaho Subscriber

Answer: You can, and in most cases will, report counseling codes along with E/M services. The behavior change intervention codes are intended to be reported in addition to an E/M service when the provider furnishes them. Most counseling sessions occur after the provider performs some sort of E/M. Consider this case study:

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Check 33208 Global to Prevent E&M Snafu

Posted on 07. May, 2010 by Editor.

When an EM service occurs during a postop global period for reasons unrelated to the original procedure, use this modifier.

Question: If the cardiologist performs a pacemaker insertion in the hospital and later visits the patient in observation, should I code the observation visit?

Georgia Subscriber

Answer: You should not charge this visit separately. Pacemaker insertion code 33208 (Insertion or replacement of permanent pacemaker with transvenous electrode[s]; atrial and ventricular) has a 90-day global period.

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Medical Coders: Use 36415 for Lab Draws

Posted on 05. May, 2010 by Editor.

You have two options depending on the next step.

Question: Our vascular office performs blooddraws and analysis for a local hospital. Can we bill for a lab draw in an office setting, and if so, what codes should we use?

Georgia Subscriber

Answer: If you’re sending your patients to an outside lab for both the blood draw and testing, you cannot report any blood draw codes. If your office collects the blood, you have two coding options, depending on the next step.

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Emergency Department Specific Exception Allows You to Sidestep Some HPI Rules

Posted on 30. Apr, 2010 by Editor.

Use these FAQs to achieve level 5.

A patient reports to the emergency department in such severe respiratory distress that she cannot communicate during the history of present illness (HPI) portion of the E/M service. The patient also presents to the ED alone via ambulance, meaning there was no one else to speak for her.

How can a coder decide on the history level for this ED E/M service? Knowing an important exception to the HPI rules in ED settings will help you accurately report these incidents.

When a physician documents that an HPI [history of present illness] is unobtainable due to patient condition, you can invoke the caveat, explains Lori Bettencourt, CPC, PCS, coder at Pro-Medbill LLC in Hampton N.H.

Benefit: The ED caveat can prevent E/M downcoding based on the E/M HPI component. Follow this FAQ to get the lowdown on all the ED caveat rules you’ll need to code correctly each time.

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