mriney@hendrick.org
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Hello all,
I have a coding question related to pacemakers and icds... The encounter summary previously read "Patient came in today for routine 1 month pacemaker check. Threshold and sensing test performed. Pacemaker function appears to be within normal limits. No changes made. No problems or complaints. Per manufacturers guidelines, due to age of pacemaker and estimated time remaining, patient scheduled to return in 1 month". Based on the highlighted text above, our billing auditor recommended we bill the appropriate codes WITHOUT ADJUSTMENT (93288 or 93289).
Long story short, the tech is claiming "because a machine makes temporary changes at the time of interrogation" this constitutes billing WITH AN ADJUSTMENT (93279,93280, 93281, 93282, 93283 or 93284). That being said, the documentation has now been changed to read "Patient came in today for post implant pacemaker check. Threshold and sensing performed, with temporary reprogrammed in assess the pacemaker function. Pacemaker function appears to be within normal limits. No problems or complaints. Patient scheduled to return in 3 months."
I am hesitant to bill WITH ADJUSTMENT because I believe the summary has been "doctored" to fit the charge. Can anyone point me in the right direction for what actually constitutes an adjustment? The CPT book does not clearly define.
Thank you, in advance,
Marjohn Riney, BA, CMPE
I have a coding question related to pacemakers and icds... The encounter summary previously read "Patient came in today for routine 1 month pacemaker check. Threshold and sensing test performed. Pacemaker function appears to be within normal limits. No changes made. No problems or complaints. Per manufacturers guidelines, due to age of pacemaker and estimated time remaining, patient scheduled to return in 1 month". Based on the highlighted text above, our billing auditor recommended we bill the appropriate codes WITHOUT ADJUSTMENT (93288 or 93289).
Long story short, the tech is claiming "because a machine makes temporary changes at the time of interrogation" this constitutes billing WITH AN ADJUSTMENT (93279,93280, 93281, 93282, 93283 or 93284). That being said, the documentation has now been changed to read "Patient came in today for post implant pacemaker check. Threshold and sensing performed, with temporary reprogrammed in assess the pacemaker function. Pacemaker function appears to be within normal limits. No problems or complaints. Patient scheduled to return in 3 months."
I am hesitant to bill WITH ADJUSTMENT because I believe the summary has been "doctored" to fit the charge. Can anyone point me in the right direction for what actually constitutes an adjustment? The CPT book does not clearly define.
Thank you, in advance,
Marjohn Riney, BA, CMPE