Wiki same day multiple same E/M Code

[lorbprce]

I have a coder submitting the same E & M code 3-4 times for the same visit just to be able to submit all of the DX codes. I know this is wrong on many levels - please help me get through to her as the many reasons this is wrong

 

[Amy Pritchett]

You are correct!! This goes against every coding guideline ever put in place. First of all, you should tell her to pick the top Principal Diagnosis and three HCC, CC, or MCC's that the patient has. More than likely, the physician has already documented all of the HCC's to the insurance company previously. Therefore, only pick the codes for the diagnoses on that date of service and file the claim. This is a RED FLAG and the insurance carrier will audit the facility and the physician.

Example: If the patient comes in with Exacerbation of COPD, treated for IDDM, has a non-healing wound, and ear infection but, has a history of depression, anxiety, and stroke......she would only code for the ECOPD, IDDM and non-healing wound.

I am not understanding why she is submitting several different claims for the same date of service just to list all the diagnosis codes. Surely, the physician is not treating more than 4 issues at a time?

Hope this helps

 

[mitchellde]

The many reasons this is wrong... First there is a rule that states you may submit only one visit level per provider, also the multiple line items will deny as duplicates, if she is trying to bypass the duplicate edit with a 25 modifier this states that you have significant and separately identifiable services for each set of diagnosis, if she is using a 59 modifier the claim will deny for invalid modifier.
Have any claims submitted already in this fashion? If so review the denials with her.

 

[lorbprce]

CPT coding more than once for the same encounter

thanks for the replies, call me brain dead cause I know that the rule is only one CPT code per encounter but I've read the guidelines several times and can't find the written rule. Can anyone help?

 

[stephanie7480]

Is AHIMA official enough?
See line 4 under E/M Coding and Reporting
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_032259.hcsp?dDocName=bok1_032259

How about this reference?
http://thehappyhospitalist.blogspot...nd-M-Codes-On-Same-Day-Is-Allowed-By-CMS.html
?only one physician in the same specialty and group should submit a CPT? code in a calendar date?

This rule is pretty basic. Is your coder new to coding??

Additionally the current claim forms have spaces for 12 diagnoses. If the provider is using 3-4 times (because she cant fit them on one claim form) than you should consider reviewing his visit note. It is highly unlikely you would have 12 let alone more than 12.