Wiki Novitas IP subsequent coding

[us063958]

Hello,
JH Novitas Medicare Webinar instructed counting BP as constitutional in exam. My understanding is you need 'any three measurements' not just one. Also, Novitas instructed only needing 2 of 3 for LOS (subsequent) and MDM does NOT need to be one of the key factors. I thought: must document 2 of 3 key factors; history, exam and medical decision making (MDM) with MDM being one of the key factors. Please advise. Thank you

 

[rthames052006]

I'm in J12 for Novitas and yes, you only need 2 of 3 for subsequent visits and can be any 2. What you want to keep in mind is that medical necessity should the overarching criterion,

I've heard some MAC's do require MDM as 1 of the 2.

 

[rthames052006]

I'm in J12 for Novitas and yes, you only need 2 of 3 for subsequent visits and can be any 2. What you want to keep in mind is that medical necessity should the overarching criterion,

I've heard some MAC's do require MDM as 1 of the 2.

 

[mhstrauss]

Hello,
JH Novitas Medicare Webinar instructed counting BP as constitutional in exam. My understanding is you need 'any three measurements' not just one. Also, Novitas instructed only needing 2 of 3 for LOS (subsequent) and MDM does NOT need to be one of the key factors. I thought: must document 2 of 3 key factors; history, exam and medical decision making (MDM) with MDM being one of the key factors. Please advise. Thank you

I just listened to this webinar earlier today; I am in Novitas JH. I do agree with Roxanne in that Novitas does not require MDM to be 1 of the deciding elements in the code selection. My personal opinion is that, if you are auditing notes, and it appears that providers are consistently beefing up the history and exam unnecessarily to be able to qualify for the higher codes, and the MDM is always really low, this presents as a good education opportunity for them in that the code selected should represent the overall medical necessity of the visit.


As far as the exam part of your question...they had me confused with that too. They allowed BP as 1 "bullet" of the constitutional exam in their example, but they were using the 4 x 4 method, which requires 4 "bullets" in each of 4 organ systems, to qualify for a detailed exam. I wish I had written down all they gave credit for, but I was just listening along. I typically don't use this method. I even asked "if you meet 3 bullets in 7 exam systems, would that qualify as detailed:" and of course she just referred me back to the link on their page, which does not give a clear answer to my question. They do have the "clinical judgement" method, which i typically go with. I work for mostly Neurologists; my docs usually hit at least 10 bullets of neuro, a few MS, and maybe a couple each in resp, cardio, general, psych, skin, eyes. I'd be pretty hard pressed to believe that this would only be exp problem focused....based on their "clinical judgement" method.