Wiki ALF Gang visits?

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Regina9

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Just wondering if anyone has experience or an opinion re: MD visits in an ALF and what number of visits would raise a red flag. For example, at one facility, in one day, approximately 18 visits were done for code 99336. Thanks in advance for all feedback:)
 
ALF "Gang visists"

Resending to see if anyone new here to assist*****

Just wondering if anyone has experience or an opinion re: MD visits in an ALF and what number of visits would raise a red flag. For example, at one facility, in one day, approximately 18 visits were done for code 99336.


Not questioning MD's ethics, just wondering for my own information about this.


Thanks in advance for all feedback.

Regina Scott, LPN, CPC-A, CMRS
 
Regina, the best was to analyze your scenario is to look at the "typical" physician time assigned to the E/M code 99336 in the CPT book which is 40 minutes. If you apply the "typical" time to the 18 visits, the physician might have spent 720 minutes or 12 hours seeing those 18 patients. The "typical" time is not a rule, it is just what it is titled, the "typical" time. However, it is the measure CMS would apply. It would be critical to also review the documentation.
 
Thank you

Linda, thank you for your reply and insight. The physician is now using EHR and I will be reviewing documentation and working with him closely going forward.

Thanks again.

Regina
 
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