Plus: CMS says MIPS participation is up, too. Many providers found the 2017 Quality Payment Program (QPP) results and 2019 incentives to be lackluster. However, recent updates from Medicare suggest that the 2018 results and 2020 payments offer something to [...]
Therapy episodes would get reimbursed less. If your claims are dominated by episodes with high therapy, no recent hospital stays, or patients with behavioral health conditions such as schizophrenia, bipolar disorder or drug addiction, Medicare’s draft for HH PPS payment [...]
Strategies get you ready for auditors’ critiques. Critical care coding is often the target of payer audits -- and mistakes can cost you. Because the critical care codes are unlike the other E/M codes in documentation requirements, these can be [...]
Question: The chart documentation seems a little brief, but this seems like a pretty sick patient. What E/M level would you assign to this chart? Ohio Subscriber Chief Complaint: Shortness of breath HPI: This 58-year-old male patient presents complaining of shortness [...]
Question: Our patient had a urinary tract infection and developed severe sepsis. The medical record doesn’t indicate a causative organism, but does mention septic shock. The patient is now home with oral antibiotics. Septic shock is resolved. How should I code [...]
Question: Our patient has a UTI with E. coli that has developed into sepsis with E. coli in the blood. According to the documentation, the sepsis isn’t resolved. The patient is home from the hospital with antibiotics. She also has acute [...]
Often, ‘V’ codes will be required for such visits. Unfortunately, every pediatrician will come across suspected abuse and neglect cases at some point during their time practicing, and although the pediatrician is typically glad when abuse is not found, it [...]
Question: What diagnosis should we assign when our physician documents "failed sedation based on the patient’s past medical history"? Codify Subscriber Answer: The appropriate diagnosis for failed sedation is 995.24 (Failed moderate sedation during procedure). Include this diagnosis with the code [...]
Question: Our office is open on Saturdays. What ICD-9 codes would the claim require to use 99051? Ohio subscriber Answer: Code 99051 (Service[s] provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic [...]
Question: The physician saw an inpatient with chronic lymphocytic leukemia who was admitted with tumor lysis syndrome due to chemotherapy and then developed SIRS related to the cancer and resulting in acute kidney failure and acute respiratory failure. How should [...]
