Pulmonology Coding Alert
Look Beyond HPI for Chronic Condition:
Question: Colorado Subscriber Unlike the 1995 version, the 1997 history elements don't require the four elements of HPI for an extended level of HPI because you can use the status of three or more chronic conditions. Therefore, the 1997 guidelines may allow you to code a higher-level E/M code for encounters that involve periodic prescription renewals without the physician having to go into as much detail. But remember that medical necessity must ultimately drive the visit's history and examination levels. Some Medicare Part B carriers allow you to apply the chronic condition alternative with the 1995 guidelines. Check with your carrier for further guidance.
Answer: Some carriers consider the information in the assessment as a condition status update. Others believe it is not attributable because this is the physician's determination of the patient's current conditions based on the current assessment. The pulmonologist may organize the notes in any manner he finds practical. For instance: He may update the illness(es) in the assessment section rather than in the HPI at the top of the note, although for audit purposes it may be helpful to reference them in the HPI section, too.
Important: Documentation should clearly indicate the chronic conditions that are updated. The pulmon- ologist must mention the status of the condition, such as "Asthma, stable (e.g., 493.01, Extrinsic asthma; with status asthmaticus). Continue medications as prescribed." Simply listing the condition on the assessment is insufficient documentation for an update.
Tip: Using the 1997 guidelines may help you report higher-level services for patients with chronic conditions that affect treatment plans, such as chronic obstructive pulmonary disease (496, Chronic obstructive pulmonary disease, not otherwise specified) and hypertension (401.1, Essential hypertension; benign).
Pulmonology Coding Alert
- Look for This $125+ Boosting Phrase in Diagnostic Scope Notes
Error averted: Drop 31575 when biopsy occurs Reporting 31575 when your pulmonologist actually performed 31525 [...] - You Be the Coder:
How to Weigh Vent Management Vs. E/M
Question: A pulmonologist visits a patient with acute respiratory failure in the medical intensive care [...] - 6 Tips Keep Your Inpatient E/M Coding On The Up-And-Up
Medicare overspends millions on upcoded inpatient visits Carriers are scrutinizing your inpatient hospital visits more [...] - OIG Is Watching Your Doctor's Nursing Home Visits
Part B payments 'vulnerable to fraud,' watchdog says Nursing homes could be hotbeds of inappropriate [...] - Reader Question:
You Can Refer to MD-Owned Sleep Lab
Question: We are a pulmonology clinic plus a sleep lab with two beds, and we [...] - Reader Question:
Stick With Nonspecific Code for MIPs & MEPs
Question: What is the correct way to bill for maximum inspiratory pressures (MIPs) and maximum [...] - Reader Question:
Must You Always Follow NCCI Edits?
Question: When specialty society guidelines differ from National Correct Coding Initiative edits, a commercial payer [...] - Reader Question:
Report Bilateral 32002 on One Line
Question: I submitted documentation with a line-itemized claim for three same-day services/procedures as follows:
--99233-25 (Hospital [...] - Reader Question:
Look Beyond HPI for Chronic Condition:
Question: The 1997 audit guidelines state that I can reach an extended history by updating [...] - Reader Questions:
Use This Diagnosis for Asthma With Croup
Question: An established patient with a history of asthma who is now taking Albuterol presents [...] - Prove Patient Is 'Critical' When You Report 99291
CPT considers many services part of the critical care package When deciding whether your pulmonologist [...]
