# 2nd attempt regarding "double dipping" per Cutting Edge article



## ollielooya (Aug 13, 2013)

Colleagues,
Hopefully this question will not be considered as "cross-posting", but its importance begs an answer from those involved in EM coding.  Am wondering how it impacts past, present and future efforts of those who code these services.  Mr. J. Verhovshek wrote "Know your Double Dipping Etiquette" in the February magazine, and the August publication had quite a response in the "Letters to the Editor" section and concluded with the following statement, _"....Any payer or auditor who continues to insist on the validity of the "double dip urban myth" ought to know better, and should be challenged."_

 I can already see the training that I received from the coding course I took will have to be revamped, no doubt!


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## ollielooya (Aug 13, 2013)

Anyone?  Totally baffled by the noise of silence regarding this topic.  May take it to the chapter meeting tonight...


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## MikeEnos (Aug 13, 2013)

I honestly don't know what you are expecting in terms of a response.  Do you have a question about it?  I think the article was excellent and it quite thoroughly dispelled the "no double dipping" myth.  He even went into the origins of how it all started, and got the relevant quotes right from the source (Dr. McCann himself)


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## ollielooya (Aug 13, 2013)

Thanks Mike for venturing in.  The article and later response in the Letter to the Editors was extremely enlightening.  It clarified some issues for me left over from the days of coding training where double dipping and the inappropriateness of doing so was taught.  I thought the article might generate comments from folks who were restricted by the double dipping"urban legend",  but on second thought--they may be reluctant to post comments.

I'm glad Mr. Verhovshek wrote this article!


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## Pam Brooks (Aug 14, 2013)

Early on in my coding career, the concept of 'double dipping' was accompanied by threats of wearing orange....but as time went by, and auditors became more savvy about CMS's expectation with HPI documentation, it became clear that it's certainly acceptable to use HPI elements to satisfy ROS bullets; CMS never intended for physicians to repeat documentation solely to support E&M key components.  We've audited without threat of 'double dipping' for quite a few years now, and when I lecture on E&M auditing, I always mention this misconception.  No external auditor I've employed in the past several years has even mentioned "double dipping", and I'd challenge anyone that did. 

John's article was excellent and appropriate.  There are many urban legends regarding coding guidelines that need to be clarified, and he did a fantastic job with this one.


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## tlewiscpc (Aug 14, 2013)

In all my training I was always told no 'double dipping'.  Seems like so many are still entrenched in that concept.   

Our Medicare carrier specifically states the following on their website and have said the same in seminars:
_
Documentation cannot be used twice under the History Component. This is referred to as 'double dipping.' Example: Allergies may be used under the ROS (Allergic/Immunologic) or under past history. _


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## MikeEnos (Aug 14, 2013)

tlewiscpc, that's a slightly different scenario that you have highlighted.  It isn't something that was documented in the HPI, and is also being counted as ROS..... what you have mentioned is actually taking something from the ROS (allergies) and trying to count it as Past Medical History.  I agree that it shouldn't be counted in both places.


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## wrightju1 (Aug 16, 2013)

I have another question regarding the "double dipping" expression.  If a provider reads an EKG or gives an injection during an office visit is it considered double dipping to charge for these services as well as credit them in the medical decision making for the e/m service?


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## OCD_coder (Aug 17, 2013)

That isn't double dipping.  Double dipping is limited to information in the history, per the legend; specifically with the Chief Complaint, HPI and ROS documentation.  Services that are separately billable when properly documented are not considered double dipping.  The limitations to using that information (services like EKG, xrays etc) would be potentially giving credit for "review of images..." in the Complexity of Data Table when the performing physician is billing for the service.  You would only give the provider credit for ordering the test/procedure.

Secondly, you must use the performing of those services when selecting a level from the Risk Table portion of the MDM.  EKG = minimal risk to the patient, minor procedure/injection w/o identified risk factors = low etc.

Use caution when the E&M is with a minor procedure if t E&M isn't significant and separate from the performing of the procedure due to the new NCCI edits guidelines.


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## PVAzCPC (Aug 23, 2013)

ollielooya said:


> Thanks Mike for venturing in.  The article and later response in the Letter to the Editors was extremely enlightening.  It clarified some issues for me left over from the days of coding training where double dipping and the inappropriateness of doing so was taught.  I thought the article might generate comments from folks who were restricted by the double dipping"urban legend",  but on second thought--they may be reluctant to post comments.
> 
> I'm glad Mr. Verhovshek wrote this article!



Could be we (me, for one!) just have not read it yet!  Now you have my curiosity piqued, I have my assignment for the weekend


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