Part B Insider (Multispecialty) Coding Alert
No E/M Coding Changes Until 2006
Clinical examples are too subjective to please CMS auditors Don't throw away your calculator yet. You'll be using the points system for evaluation and management coding for another year. A recent meeting of the E/M editorial panel reviewed the results of the pilot group that tried to code using clinical examples instead of the 1995 or 1997 guidelines. The panel went over the E/M coding that physicians arrived at from the case scenarios posted online by the AMA. The results were not encouraging, say sources close to the process. Originally, "clinical examples" were supposed to take effect next year. Now, the best case scenario is that they'll take effect in 2006, says Cheryl Gregg Fahrenholtz, president of Preferred Healthcare Solutions in Bellbrook, OH. It'll take that long to get a usable system in place, she says. "Right now, a case scenario is too subjective," adds Fahrenholtz. Because the AMAhad been focusing entirely on subjective clinical examples, CMS'response "kind of threw them for a loop," she says. The new version will have to be some combination of numerical metrics with narrative case scenarios, says Fahrenholtz.
For clinical examples to go forward, there needs to be a mechanism in place to let auditors figure out whether people are coding correctly, Fahrenholtz adds. If a methodology is based solely on case scenarios, "you don't have any counting system for auditing purposes." The Centers for Medicare & Medicaid Services wants there to be some way to quantify whether the physician met certain coding standards.
"It would have been very difficult to enforce them because they're awfully subjective," agrees Jim Collins, president of Compliant MD in Matthews, NC. It wouldn't be possible to provide examples that covered every single possible encounter in the field, so doctors would have to extrapolate to arrive at E/M levels. It would be hard for doctors to defend themselves during an audit, and also hard for auditors to figure out a fair comparison for a particular procedure with the examples.
Part B Insider (Multispecialty) Coding Alert
- EVALUATION & MANAGEMENT:
No E/M Coding Changes Until 2006
Clinical examples are too subjective to please CMS auditors Don't throw away your calculator yet. [...] - PRESCRIPTIONS:
Beware Of Compliance Hurdles In Brave New E-Scrip World
The Medicare Modernization Act calls for the Centers for Medicare & Medicaid Services to encourage [...] - BEWARE OUT-OF-STATE PRESCRIPTIONS
Beware of writing a prescription for a patient living in another state, especially if you're [...] - DIAGNOSIS CODES:
Use New Decubitus Ulcer ICD-9 Codes For 15999 Claims
At last,a way to explain ulcers that aren't bed sores Billing for excision of decubitus [...] - HIGH-END BILLING PUTS YOUR MEDICAL RECORDS ON THE LINE
Feds see through alleged cover-up at KY clinic If your billing patterns stick out from [...] - MODIFIERS:
Don't Throw Away E/M Reimbursement On Last-Minute Decisions
Follow these guidelines to get paid for -57 modifier Surgeons are throwing away reimbursement for [...] - Steer Clear Of Keeping Payers In The Dark
Biller faces fraud charges for allegedly skewing the facts on claims Fraud fighters keep cracking [...] - MODIFIERS:
Consider Using Time-Based Billing For E/M Visits With Modifier -57
Remember the 50-percent rule and you'll come out ahead. An evaluation and management visit in [...] - Part B Coding Coach:
Want To Make $43 More Per E/M Visit?
4 steps help you avoid unnecessary downcoding If you underestimate your physician's medical decision-making, you [...] - PHYSICIAN NOTES:
Non-Compliant CMNs Place You At Risk
Latest physician-supplier scam allegedly billed Medicare $3.7 million Before you sign a certificate of medical [...]
