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Just sent in an eMews from WPS
WPS Medicare Part B Legacy and MAC eNews for Thursday, March 22, 2012
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Status of Three Chronic or Inactive Conditions in the History of Present Illness (HPI)
Effective for dates of service April 19, 2012, and after WPS Medicare Part B will change the way we adjudicate the extended level of HPI when practitioners use the 1995 Documentation Guidelines (DG) to document their services.
The 1995 DG states: "An extended HPI consists of four or more elements of the HPI." The 1997 DG states: "An extended HPI consists of at least four elements of the HPI or the status of at least three chronic or inactive conditions." WPS Medicare Part B applied the 1997 DG statement to medical record documentation under both the 1995 and the 1997 DG based on a communication received from the Centers for Medicare&Medicaid Services (CMS) several years ago. The Comprehensive Error Rate Testing (CERT) contractor does not have that same communication and does not adjudicate documentation that way. Therefore, effective for dates of service April 19, 2012, and after, WPS Medicare Part B will no longer apply the statement from the 1997 DG to documentation when practitioners use the 1995 DG.
WPS Medicare Part B Legacy and MAC eNews for Thursday, March 22, 2012
********************************************************************
Status of Three Chronic or Inactive Conditions in the History of Present Illness (HPI)
Effective for dates of service April 19, 2012, and after WPS Medicare Part B will change the way we adjudicate the extended level of HPI when practitioners use the 1995 Documentation Guidelines (DG) to document their services.
The 1995 DG states: "An extended HPI consists of four or more elements of the HPI." The 1997 DG states: "An extended HPI consists of at least four elements of the HPI or the status of at least three chronic or inactive conditions." WPS Medicare Part B applied the 1997 DG statement to medical record documentation under both the 1995 and the 1997 DG based on a communication received from the Centers for Medicare&Medicaid Services (CMS) several years ago. The Comprehensive Error Rate Testing (CERT) contractor does not have that same communication and does not adjudicate documentation that way. Therefore, effective for dates of service April 19, 2012, and after, WPS Medicare Part B will no longer apply the statement from the 1997 DG to documentation when practitioners use the 1995 DG.