8/19/2017. The OIG Report
|
|
- Isabel Hood
- 5 years ago
- Views:
Transcription
1 This presentation was created by me with the best intentions and believable resources. I however am not a lawyer, doctor or self-proclaimed expert, but I have watched plenty on TV. The information and sources are as accurate as I could get them, however if you go back to your office saying Linda said so, youwill get funny looks. The OIG Report 1
2 The guidelines are not great We are asking for extra money That won t pay without a 25 The OIG decided it was worth a look Came out in 2005 Used claims from 2002 In 2002, Medicare allowed $1.96 billion for approximately 29 million services billed using modifier randomly selected claims 431 providers were able to be contacted, Other 19 claims were excluded 35% of claims using modifier 25 that Medicare allowed in 2002 did not meet program requirements These claims totaled $538 million in improper payments that Medicare and/or beneficiaries made. The payments were improper because the services were deemed (1) noncovered because they did not meet the requirements for use of modifier 25 or (2) undocumented due to failure to meet basic Medicare documentation requirements 2
3 Twenty-eight percent of all providers in the sample population used modifier 25 on more than 50 percent of their claims, thus using it unnecessarily. Claims submitted for some providers included the modifier on every item billed to Medicare in 2002 both procedures and E/M services. Evaluation and management (E/M) services that are necessary for the performance of a medical procedure (for example, assessing the site/condition of the problem area, explaining the procedure, and obtaining informed consent) are includedin Medicare payments for the procedure. 3
4 The governing source for determining appropriate payment is CMS s Internet- Only Manual. Chapter 12, section 40.2 of the manual states: Modifier 25 is used to facilitate billing of evaluation and management services on the day of a procedure for which separate payment may be made. It is used to report a significant, separately identifiable evaluation and management service performed by the same physician on the day of a procedure. The physician may need to indicate that on the day a procedure or service that is identified with a CPT code was performed, the patient s condition required a significant, separately identifiable evaluation and management service above and beyond the usual preoperative and postoperative care associated with the procedure or service that was performed. Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service It may be necessary to indicate that on the day a procedure or service identified by a CPT code was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. A significant, separately identifiable E/M service is defined or substantiated by documentation that satisfies the relevant criteria for the respective E/M service to be reported. The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M services on the same date. This circumstance may be reported by adding modifier 25 to the appropriate level of E/M service. Note: This modifier is not used to report an E/M service that resulted in a decision to perform surgery. 4
5 The CPT codes for procedures do include the evaluation services necessary prior to the performance of the procedure (e.g., assessing the site/condition of the problem area, explaining the procedure, obtaining informed consent), however, when significant and identifiable (i.e., key components/counseling) E/M services are performed, these services are not included in the descriptor for the procedure or service performed. Medical record documentation should include: Clinical information confirming that the E/M service billed was above and beyond the E/M services included in the procedure The physician pre-service work for the skin biopsy includes: discussion of probable diagnoses and indication for the biopsy procedure, risks and benefits, description of biopsy procedure method, and expected result or scar. An informed consent is obtained. 5
6 Does the CPT have a global period? Does the CPT have a Pre-Op period? 6
7 Closed Treatment of metatarsal fracture; without manipulation, each EGD with biopsy 7
8 XXX indicator Does the global concept apply? Let s just add the 25 to be safe WPS Modifier 25 Fact Sheet Appropriate usage: The procedure performed has a global period listed on the Medicare Fee Schedule Relative Value File. This global period could be 000, 010, or 090 days Chest X-ray 8
9 Modifier 25 may be appended to E&M services reported with minor surgical procedures (global period of 000 or 010 days) or procedures not covered by global surgery rules (global indicator of XXX). Since minor surgical procedures and XXX procedures include pre-procedure, intra-procedure, and post-procedure work inherent in the procedure, the provider should not report an E&M service for this work. Furthermore, Medicare Global Surgery rules prevent the reporting of a separate E&M service for the work associated with the decision to perform a minor surgical procedure whether the patient is a new or established patient. The following statements are false I can always use this modifier when I did not plan the procedure. I can always use this modifier when the diagnoses are different. I can never use this modifier when the diagnoses are the same. An E&M service is separately reportable on the same date of service as a procedure with a global period of 000, 010, or 090 under limited circumstances If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. In general E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. 9
10 CCI MANUAL: The decisionto perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is new to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure IOM Ch.12: What is not included in the Surgical package: Initial consultation or evaluation of the problem by the surgeon to determine the need for surgery. Please note that this policy only applies to major surgical procedures.; The initial evaluation is always included in the allowance for a minor surgical procedure 10
11 IOM Ch.12: Visits by the same physician on the same day as a minor surgery or endoscopy are included in the payment for the procedure, unless a significant, separately identifiable service is also performed. Where the decision to perform the minor procedure is typically done immediately before the service, it is considered a routine preoperative service and a visit or consultation is not billed in addition to the procedure Does not have to be different but don t put a different one just to get paid Different diagnoses are not required for reporting the E/M service on the same date as the procedure or other service with a global fee period. Modifier - 25 is added to the E/M code on the claim CMS Transmittal
12 To decide if an E&M service is separately reportable with modifier 25, AAPCsuggests: Ask yourself, Can I pick out from the documentation a clear history, exam, and [medical decision making] apart from any other procedures the physician performs on the same day? If so, you ve probably got a billable service with modifier When modifier 25 is appropriately appended to an E&M service and is submitted on the same date of service, by the same professional provider or other qualified health care provider, as a minor procedure, the E&M service is reimbursed at 50 percent of the applicable fee schedule amount. 12
13 Payments for E&M services with a 25 modifier exceeded $2.5 billion in 2015 A physician examines a patient with a fever, headache, vomiting, and stiff neck. A spinal tap is performed as well as the services described in code The -25 modifier is appended to code to indicate that both a significant E/M service and a procedure were performed on a given day. Winter 1993, CPT Assistant 13
14 A physician examines a new patient exhibiting symptoms of an upperrespiratory infection that has progressed to unilateral purulent nasal discharge and discomfort in the right maxillary teeth. The physician performs and documents a detailed history and detailed examination. The physician determines that the medical decision making is of low complexity and also documents this in the patient s medical record. During the examination, the patient communicates to the physician that the hearing in his left ear is not as distinct as his right ear. Upon examination of the left ear, the physician notes a large amount of impacted cerumen. The physician proceeds to remove the impacted cerumen in the patient s left ear. To report this patient encounter, the physician appends Modifier -25 to code 99203, and separately reports code 69210, Removal impacted cerumen (separate procedure), one or both earsto indicate that both a significant E/M service and a procedure were performed on a given day. May 2003, CPT Assistant If a physician determines that a new patient with head trauma requires sutures, confirms the allergy and immunization status, obtains informed consent, and performs the repair, an E&M service is not separately reportable. However, if the physician also performs a medically reasonable and necessary full neurological examination, an E&M service may be separately reportable. CCI Manual, Chapter 1 A patient was scheduled to have a lesion removed from her right leg. The physician examined the lesion, infiltrated the lesion with 1% lidocaine. The lesion was removed, and a simple closure (11401) was performed. 14
15 An established patient visited her internist for a follow up of hypertension and diabetes. The patient also complained of shoulder pain. The physician performed a problem focused history and exam, evaluated the patients' hypertension, and determined the blood pressure was higher than usual and adjusted the medication regimen. The patient's blood glucose was normal. The physician also evaluated the shoulder and determined the patient would benefit from an arthrocentesis. At a follow-up visit for the patient s stable hypertension and osteoarthritis, the patient also complains of a troublesome skin lesion that you remove at that same encounter. A 4-year-old slips on the edge of a pool, strikes the mandible and experienced a 3.5 cm serrated and curvilinear, full-thickness laceration of the chin. She is a new patient in urgent care, and the physician elects to widely excise the serrated skin margins and undermine the dermis from the subcutaneous tissue to reduce the tension on the suture line. The wound is then approximated in layers with absorbable interrupted sutures and a running subcuticular closure. 15
16 45 year old diabetic in for wound care of a buttock ulcer. This is the third visit in the past 6 weeks. The physician removes the bandage and re-evaluates the wound deciding to continue with forcep debridement, replacement of the bandage, and asks the patient to come back in 2 weeks. Modifier -25 is not the same as modifier -57, decision for surgery for a major procedure. Modifier - 25 should never be used solely as decision for surgery for a minor procedure. According to CMS, visits by the same physician on the same day as a minor surgery or endoscopy are included in the payment for the procedure. In addition, it does not matter if it is a new or an established patient. The rule is the same for both. 16
17 You do not have to have another different. diagnosis to report an EM service and a procedure on the same day If a provider sends you an EM service and a procedure on the same day with the same diagnosis and the provider did not indicate modifier -25 on the billing information, you cannot automatically apply modifier -25. You must review the documentation to make sure modifier -25 is appropriate. There is no such thing as automatically assigning modifier Is the provider is looking for a more significant or systemic issue outside of the complaint? 2. Is the exam more extensive? 3. Does the medical decision making reflect differential diagnoses and/or additional 17
18 Whether or not to apply modifier -25 will most often be a judgement call based on the documentation. Unfortunately, there is no one case fits all answer to the modifier -25 issue. Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC, CCC, AAPC Fellow lvargas@upamed.org 18
Modifier -25 Significant, Separately Identifiable E/M Service
Manual: Policy Title: Reimbursement Policy Modifier -25 Significant, Separately Identifiable E/M Service Section: Modifiers Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM028 Last Updated:
More informationProgramming a Spinal Cord Neurostimulator
Programming a Spinal Cord Neurostimulator August 10, 2017 My surgeon wants to bill 95972 for programming along with placement of a spinal neurostimulator. Isn t the programming inclusive to the surgical
More informationPost-Op hemorrhage repair. Is it billable?
Post-Op hemorrhage repair. Is it billable? August 10, 2017 Can I bill for taking the patient back to the OR to explore and repair post-op hemorrhage on day post-op? I heard that all complications are included
More informationSee the Time chapter for complete instructions regarding how to code using time as the controlling E/M factor.
2015 EM Survival Guides Chapter 1: Office or Other Outpatient Visit (99201-99215) You should apply 99201-99215 for E/M visits in the office or other outpatient setting. These codes distinguish between
More informationPostoperative Sinus Endoscopy and/or Debridement Procedures
Manual: Policy Title: Reimbursement Policy Postoperative Sinus Endoscopy and/or Debridement Procedures Section: Surgery Subsection: None Date of Origin: 10/1/2009 Policy Number: RPM009 Last Updated: 7/3/2017
More informationThe World of Evaluation and Management Services and Supporting Documentation
The World of Evaluation and Management Services and Supporting Documentation Presented by Cahaba Government Benefit Administrators, LLC Provider Outreach and Education May 14, 2009 Disclaimers Disclaimer
More informationFor Vanderbilt Medical Center Carolyn Buppert, NP, JD Law Office of Carolyn Buppert
For Vanderbilt Medical Center Carolyn Buppert, NP, JD Law Office of Carolyn Buppert www.buppert.com Describe the services in critical care that nurse practitioners perform that are billable Discuss what
More informationGLOBAL DAYS POLICY. Policy Number: SURGERY T0 Effective Date: January 1, 2018
GLOBAL DAYS POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: SURGERY 011.37 T0 Effective Date: January 1, 2018 Table of Contents Page INSTRUCTIONS FOR USE... 1 APPLICABLE LINES OF BUSINESS/PRODUCTS...
More informationPayment Policy: Visits On Same Day As Surgery Reference Number: CC.PP.040 Product Types: ALL Effective Date: 03/01/2018
Payment Policy: Visits On Same Day As Surgery Reference Number: CC.PP.040 Product Types: ALL Effective Date: 03/01/2018 Revision Log See Important Reminder at the end of this policy for important regulatory
More informationGlobal Days Policy. Approved By 7/12/2017
Global Days Policy Policy Number 2018R0005A Annual Approval Date 7/12/2017 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS You are responsible for submission of accurate
More informationICD-9 (Diagnosis) Coding
1 Disclaimer This presentation is intended only for use by Tulane University faculty, staff, and students. No copy or use of this presentation should occur without the permission of Tulane University.
More informationSee the Time chapter for complete instructions on how to code using time as the controlling factor when selecting an E/M code.
2015 EM Survival Guides Chapter 4: Initial Hospital Care (99221-99223) You should select the appropriate-level initial hospital care code (99221-99223) using the key E/M criteria of history, examination
More informationDocumenting & Coding for Compliance
Documenting & Coding for Compliance Department of Family and Community Medicine October 17, 2012 UNMMG Compliance Documentation Documentation Why is it important? Enables the physician and other health
More informationModifiers 58, 78, and 79 Staged, Related, and Unrelated Procedures
Manual: Policy Title: Reimbursement Policy Modifiers 58, 78, and 79 Staged, Related, and Unrelated Procedures Section: Modifiers Subsection: None Date of Origin: 9/22/2004 Policy Number: RPM010 Last Updated:
More informationE/M Auditing: History is the Key
E/M Auditing: History is the Key By Brandi Tadlock CPC, CPC-P, CPMA, CPCO CPC, CPMA, CEMC, CPC-H, CPC-I SUMMARY Review the history component in your E/M documentation to make sure it tells the patient
More informationSupervision of Residents/Chain of Command
Supervision of Residents/Chain of Command Creighton University Department of Surgery Residency Training Program Chain of command for Surgery residents at CUMC PGY1: The intern on call covers the two general
More informationPresented for the AAPC National Conference April 4, 2011
Presented for the AAPC National Conference April 4, 2011 Penny Osmon, BA, CPC, CPC-I, CHC, PCS Director of Educational Strategies - Wisconsin Medical Society penny.osmon@wismed.org CPT codes, descriptions
More informationGlobal Surgery Package for Professional Claims
Manual: Policy Title: Reimbursement Policy Global Surgery Package for Professional Claims Section: Administrative Subsection: None Policy Number: RPM011 Date of Origin: 1/1/2000 Last Updated: 3/6/2017
More informationE & M Coding. Welcome To The Digital Learning Center. Today s Presentation. Course Faculty. Beyond the Basics. Presented by
Welcome To The Digital Learning Center Presented by Your Partner In Building High Performance Practices Today s Presentation E & M Coding Beyond the Basics Course Faculty R. Thomas (Tom) Loughrey, MBA,
More informationAs The Code Turns A Day In The Life Of A Code. Disclaimer. Objectives 9/13/2013
As The Code Turns A Day In The Life Of A Code Yvonne D Dailey, CPC, CPC-I, CPB Susan Ward, CPC, CPC-H, CPC-I, CEMC, CPCD, CPRC Jaci Johnson, CPC, CPC-H, CPMA, CPC-I, CEMC Melody Irvine, CPC, CPMA, CPC-I,
More informationProcedure Codes Assigned to Surgical Benefit Categories
Manual: Policy Title: Reimbursement Policy Procedure Codes Assigned to Surgical Benefit Categories Section: Surgery Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM023 Last Updated: 4/5/2017
More informationEmpire BlueCross BlueShield Professional Reimbursement Policy
Subject: Global Surgery NY Policy: 0012 Effective: 02/01/2014 05/31/2014 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria
More informationIMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY
Global Surgery Policy Number GLS03272013RP Approved By UnitedHealthcare Medicare Committee Current Approval Date 04/09/2014 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to UnitedHealthcare
More informationNon-Chemotherapy Injection and Infusion Services Policy, Professional
Non-Chemotherapy Injection and Infusion Services Policy, Professional Policy Number Annual Approval Date 3/14/2018 Approved By Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy
More informationStart with the Problem
Start with the Problem Jen Godreau, BA, CPC, CPEDC Director of Development & Operations Supercoder.com jenniferg@supercoder.com December 2011 Phone: (866)-228-9252 E-Mail: customerservice@supercoder.com
More informationTrauma. Level 2. This resident can lead a to recognize common. This resident can. accurately diagnose. team that cares for traumatic conditions and
Page 1 of 7 Trauma Subject Name Status Employer Program Rotation Evaluation Dates Evaluated by: Evaluator Name Status Employer Program 1 (Trauma) Patient Care: Ward Care This resident is not able lead
More informationE/M: Coding Opportunities- Documentation is key
E/M: Coding Opportunities- Documentation is key Compiled and Presented by: Suzan Berman CPC, CEMC, CEDC The duplication of this presentation, all or in part, without the expression permission of the presenter,
More informationReporting Diagnosis Codes in ICD-10
Reporting Diagnosis Codes in ICD-10 My physician treated a patient for dysphasia secondary to an acute cerebral infarction in the inpatient rehab hospital. Do I need to report two diagnosis codes in ICD-10?
More informationHealth Assessment Student Handbook
Health Assessment Student Handbook Fall 2017 Your guide to the Shadow Health Digital Clinical Experience UGV.1 Table of Contents WELCOME!... 3 HEALTH HISTORY Instructions... 4 HEENT Instructions... 5 RESPIRATORY
More informationEVALUATION AND MANAGEMENT: GETTING PAID FOR WHAT YOU DO
EVALUATION AND MANAGEMENT: GETTING PAID FOR WHAT YOU DO Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO Sandy Giangreco, RHIT, CCS, CCS-P, CHC, CPC, COC, CPC-I, COBGC Agenda 2014 OIG Report CMS Documentation
More informationHow does one report the performance of both a screening mammogram on the right breast and a diagnostic on the left breast at the same encounter?
1 of 6 05/27/2008 4:21 PM FAQ Wisconsin Medical Society FAQ If you have any questions regarding the following, please direct all your questions to: efaq@wismed.org. Medicare / Medicaid Medicare does not
More informationDisclaimer. The information in this presentation was current at
As The Code Turns A Day In The Life Of A Code Yvonne Daily, CPC, CPC I Cyndi Stewart, CPC, CPC H, CPMA, CPC I Susan Ward, CPC, CPC H, CPC I, CEMC, CPCD, CPRC Chandra Stephenson, CPC, CPC H, CPMA, CPC I,
More informationa. 95 guidelines are based on body systems 97 systems based on bullet points.
Interview questions for freshers Medical Coding Interview Questions 1) What is the basic difference between 95 and 97 guidelines? a. 95 guidelines are based on body systems 97 systems based on bullet points.
More informationMessage Response Message
Message If established pt wouldn't 2 out of 3 still require the level for slide 5? Response Message Can you re-state your question? I am unclear on what you are asking. Thanks You stated that even when
More informationMedical Decision Making
Medical Decision Making Jen Godreau, BA, CPC, CPMA, CPEDC Director of Development & Operations Supercoder.com jenniferg@supercoder.com February 2012 What s he thinking? What Is the Table of Risk? 1 of
More informationAnthem Blue Cross and Blue Shield Commercial Professional Reimbursement Policy
Subject: Global Surgery IN, KY, MO, OH, WI Policy: 0012 Effective: 01/01/2018 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria
More informationGuidance For Modifier 24 Usage
March 4, 2016 Guidance For Modifier 24 Usage Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician during a Postoperative Period) has generated more scrutiny lately because of
More informationFamily Medicine Residency Surgery Rotation
Family Medicine Residency Surgery Rotation Rotation Goal The overall goal for the educational experience provided in the areas of general surgery, trauma surgery, office orthopedic surgery and sports medicine,
More informationUNMH Family Medicine Clinical Privileges
All new applicants must meet the following requirements as approved by the UNMH Board of Trustees effective: 07/31/2015 INSTRUCTIONS Applicant: Check off the "Requested" box for each privilege requested.
More informationGlobal Surgery Package
Private Property of Florida Blue. This payment policy is Copyright 2017 Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission
More informationFew non-clinical issues have created as
from October 2001 How to Get All the 99214s You Deserve It s easier than you might think to get what s coming to you. Emily Hill, PA-C Few non-clinical issues have created as much controversy as the CPT
More informationReimbursement Policy (EXTERNAL)
Subject: Consultations Reimbursement Policy (EXTERNAL) Effective Date: 01/01/15 Committee Approval Obtained: 06/06/16 Section: E&M/Medicine ***** The most current version of our reimbursement policies
More informationNEW YORK STATE MEDICAID PROGRAM MIDWIFE PROCEDURE CODES
NEW YORK STATE MEDICAID PROGRAM MIDWIFE PROCEDURE CODES Table of Contents GENERAL INFORMATION... 3 SERVICES PROVIDED IN ARTICLE 28 FACILITIES... 4 MMIS MODIFIERS... 4 MEDICINE SECTION... 7 GENERAL INFORMATION
More informationUniCare Professional Reimbursement Policy
UniCare Professional Reimbursement Policy Subject: Global Surgery Policy #: UniCare 0012 Adopted: 07/15/2008 Effective: 08/01/2017 Coverage is subject to the terms, conditions, and limitations of an individual
More informationRotation Specific Learning Objectives CCFP-EM Residency Program. Plastic Surgery
Rotation Specific Learning Objectives CCFP-EM Residency Program Plastic Surgery of the Rotation To utilize the relevant competencies contained within the CanMEDS-FM roles to effectively evaluate, diagnose
More informationEMERGENCY MEDICINE CLINICAL ROTATION COMPETENCY BASED CURRICULUM
CLINICAL ROTATION COMPETENCY BASED CURRICULUM EMERGENCY MEDICINE During the third year of the curriculum, students expand their knowledge of emergent conditions and gain the ability to apply the knowledge
More informationNEW YORK STATE MEDICAID PROGRAM MIDWIFE PROCEDURE CODES
NEW YORK STATE MEDICAID PROGRAM MIDWIFE PROCEDURE CODES Table of Contents GENERAL INFORMATION ------------------------------------------------------------------------------------------ 2 STATE DEPARTMENT
More informationSCOPE OF PRACTICE PGY 1-6
PGY1 Complete history and physical on each patient admitted as assigned by the attending surgeon. Participate in daily ward rounds. Assist operating surgeons and senior residents in the operating room
More informationEmpire BlueCross BlueShield Professional Commercial Reimbursement Policy
Subject: Global Surgery NY Policy: 0012 Effective: 10/01/2016 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria listed below.
More informationMedical Necessity verses Medical Decision Making. Presented Kevin Solinsky,CPC, CPC-I, CEDC, CEMC of Healthcare Coding Consultants, LLC
Medical Necessity verses Medical Decision Making Presented Kevin Solinsky,CPC, CPC-I, CEDC, CEMC of Healthcare Coding Consultants, LLC Objectives We will first look at Medical Decision Making in detail.
More informationElectronic Health Records - Advantages and Pitfalls of Documentation
Electronic Health Records - Advantages and Pitfalls of Documentation Kansas City, KS HCCA Regional Conference September 25, 2015 1:00 P.M. 2:00 P.M. Presented by: Cynthia A. Swanson, RN, CPC, CEMC, CHC,
More informationEvaluation and Management
Evaluation and Management CPT CPT copyright 2011 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by
More informationUNMH Family Medicine Clinical Privileges. Name: Effective Dates: From To
All new applicants must meet the following requirements as approved by the UNMH Board of Trustees, effective April 28, 2017: Initial Privileges (initial appointment) Renewal of Privileges (reappointment)
More informationTechnical Component (TC), Professional Component (PC/26), and Global Service Billing
Manual: Policy Title: Reimbursement Policy Technical Component (TC), Professional Component (PC/26), and Global Service Billing Section: Modifiers Subsection: None Date of Origin: 1/1/2000 Policy Number:
More informationCREATING AN AUDIT PLAN FOR PHYSICIAN OFFICES. Katherine Abel, CPC, CPB, CPMA, CPPM, CPC-I, AAPC Fellow Director of Curriculum AAPC
CREATING AN AUDIT PLAN FOR PHYSICIAN OFFICES Katherine Abel, CPC, CPB, CPMA, CPPM, CPC-I, AAPC Fellow Director of Curriculum AAPC OIG Compliance Guidance Implementing written policies, procedures and standards
More informationRegions Hospital Delineation of Privileges Family Medicine
Regions Hospital Delineation of Privileges Family Medicine Applicant s Name: Last First M. Instructions: Place a check-mark where indicated for each core group you are requesting. Review education and
More informationReimbursement Policy. Subject: Consultations Effective Date: 05/01/05
Reimbursement Policy Subject: Consultations Effective Date: 05/01/05 Committee Approval Obtained: 06/06/16 Section: Evaluation and Management *****The most current version of the Reimbursement Policies
More informationNEW YORK STATE MEDICAID PROGRAM PODIATRY PROCEDURE CODES
NEW YORK STATE MEDICAID PROGRAM PODIATRY PROCEDURE CODES Table of Contents GENERAL INFORMATION AND INSTRUCTIONS... 3 MMIS MODIFIERS... 12 LABORATORY SERVICES PERFORMED IN A PODIATRIST'S OFFICE... 13 MEDICAL
More informationSample page. Orthopaedics: Hips & Below. A comprehensive illustrated guide to coding and reimbursement CODING COMPANION
CODING COMPANION 2018 Orthopaedics: Hips & Below A comprehensive illustrated guide to coding and reimbursement POWER UP YOUR CODING with Optum360, your trusted coding partner for 32 years. Visit optum360coding.com.
More informationCalculating E&M codes & 2018 Medicare Physician Fee Schedule Proposed Rule. Grace Wilson, RHIA
Calculating E&M codes & 2018 Medicare Physician Fee Schedule Proposed Rule Grace Wilson, RHIA Objectives 2018 Medicare Physician Fee Schedule E/M Coding Overview Documentation Examples Proposed Documentation
More informationCritical Care What Makes this so Difficult
Critical Care What Makes this so Difficult Presented by Angela Jordan, CPC Senior Managing Consultant AAPC National Advisory Board, Southwest September 2016 Disclaimer The speaker has no financial relationship
More informationGetting paid properly requires a thorough knowledge of the rules.
Selecting E/M Codes For Established Patients Getting paid properly requires a thorough knowledge of the rules. Kenneth F. Malkin, D.P.M. Bio: Dr. Malkin is a diplomate of the American Board of Quality
More informationIncident to Billing. Incident-To. Charla Prillaman, CPC, CPCO, CPMA, CPC-I,CCC, CEMC, CHCO Breakout B4, Friday, 9/7/12
Incident to Billing Incident-To SING REVENUES IN THE BUSINESS OFFICE Charla Prillaman, CPC, CPCO, CPMA, CPC-I,CCC, CEMC, CHCO Breakout B4, Friday, 9/7/12 Today s Objectives Increase understanding of the
More informationEvaluation and Management Auditing Back to the Basics. Objectives. Audit Start with the benchmarks CMS MEDPAR by specialty 4/22/2013
Evaluation and Management Auditing Back to the Basics E&M Audit Sonda Kunzi, CPC, CPMA, CPPM, CPC-I Associate Director, Cohen Healthcare Consulting Ltd. Objectives Discuss good basic audit techniques Review
More informationMost doctors view coding as a necessary evil, says. The Physician s Role in Coding. Chapter in Brief:
ACCURATE BILLING AND CODING The Physician s Role in Coding Many physicians would be happy to delegate all coding issues to the staff, but doctors play an integral role in the coding process. Chapter in
More informationPatient information. Ankle Arthroscopy. Trauma and Orthopaedic Directorate PIF 713 / V4
Patient information Ankle Arthroscopy Trauma and Orthopaedic Directorate PIF 713 / V4 Your Consultant / Doctor has advised you to have an ankle arthroscopy. The aim of surgery is to help to confirm a diagnosis
More informationGlobal Period for Surgery. Is it billable?
Global Period for Surgery. Is it billable? August 10, 2017 Question: My patient presented to the ED with an infection at the incision site from a surgery that I did 4 weeks ago. It has a 90 day global.
More informationOutpatient Observation Services
Outpatient Observation Services Presented by: Gina Hobert, MBA, CHC, CPC-I, CPMA, CEMC, CRC Sr. Manager, Baker Newman Noyes Definition MCR Benefit Policy Manual, CMS 100-02, Chapter 6, 20.6 A. Outpatient
More informationWalk-in Clinic. Dear Patients. Frequently Asked Questions (FAQ)
Walk-in Clinic Klamath Tribal Health & Family Services 330 Chiloquin Boulevard Chiloquin, OR 97624 (541) 882-1487 Frequently Asked Questions (FAQ) Monday Friday, 8:00 a.m. 3:30 p.m. * First Wednesday of
More informationSample page. General Surgery/ Gastroenterology. A comprehensive illustrated guide to coding and reimbursement CODING COMPANION
CODING COMPANION 2018 General Surgery/ Gastroenterology A comprehensive illustrated guide to coding and reimbursement POWER UP YOUR CODING with Optum360, your trusted coding partner for 32 years. Visit
More informationNEW YORK STATE MEDICAID PROGRAM NURSE PRACTITIONER PROCEDURE CODES
NEW YORK STATE MEDICAID PROGRAM NURSE PRACTITIONER PROCEDURE CODES Table of Contents GENERAL INFORMATION 2 STATE DEPARTMENT OF HEALTH CONDITIONS FOR PAYMENT 3 PRACTITIONER SERVICES PROVIDED IN HOSPITALS
More informationRiver City AAPC. Jacksonville, FL
1. A 15 year-old male arrives in the family practice physicians office complaining of severe low right side abdominal pain. Following the examination, the physician determines that patient has appendicitis
More informationReimbursement Policy. BadgerCare Plus. Subject: Consultations
Subject: Reimbursement Policy Effective Date: Committee Approval Obtained: Section: Evaluation and 04/20/18 04/20/18 Management *****The most current version of our reimbursement policies can be found
More informationThe ASA defines anesthesiology as the practice of medicine dealing with but not limited to:
1570 Midway Pl. Menasha, WI 54952 920-720-1300 Procedure 1205- Anesthesia Lines of Business: All Purpose: This guideline describes Network Health s reimbursement of anesthesia services. Procedure: Anesthesia
More information*OB/Gyn. Hospital Billing. April 2, 2014 Erika Bloomquist, CPC
OB/Gyn Hospital Billing April 2, 2014 Erika Bloomquist, CPC Initial Date Diagnoses Billing Level Code Patient Label ZK 3/1 1,2 A1 Or two patient identifiers BB 3/2 1,2 S2 TS 3/3 1,2 D1 Inpt. Obs Transfer
More informationInstitute on Medicare and Medicaid Payment Issues March 28 30, 2012 Robert A. Pelaia, JD, CPC
I. Introduction Institute on Medicare and Medicaid Payment Issues March 28 30, 2012 Robert A. Pelaia, JD, CPC Senior University Counsel for Health Affairs - Jacksonville 904-244-3146 robert.pelaia@jax.ufl.edu
More informationNEW JERSEY. Downloaded January 2011
NEW JERSEY Downloaded January 2011 SUBCHAPTER 25. MANDATORY NURSE STAFFING 8:39 25.1 Mandatory policies and procedures for nurse staffing (a) There shall be a full time director of nursing or nursing administrator
More informationGlobal Surgery Fact Sheet
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Global Surgery Fact Sheet Definition of a Global Surgical Package This fact sheet is designed to provide education on the
More informationHaving a sentinel lymph node biopsy and wide excision for melanoma
Having a sentinel lymph node biopsy and wide excision for melanoma This leaflet has been given to you to help answer questions you may have about sentinel lymph node biopsy and wide excision. It explains
More informationPLASTIC AND HAND SURGERY CORE OBJECTIVES
PLASTIC AND HAND SURGERY CORE OBJECTIVES Through rotation on the plastic and hand surgery service, residents shall attain the following goals: I. Patient Care A. Preoperative Care: Residents will evaluate
More informationHEALTH. CENTER Main St NE, Suite 101 PO Box 507 Duvall, WA ph fax Dr. Jeffrey P. Metcalf
Welcome To Our Office Name I prefer to be called First MI Last Home Address: Street City Zip Mailing Address: Street City Zip Phone: ( ) ( ) ( ) Home Cell Work E-mail: Birth : / / Age: Male / Female Marital
More informationCapturing E/M Services in the HOPD
Capturing E/M Services in the HOPD AAPC Regional Conference Anaheim, CA Linda Martien, COC, CPC, CPMA September 2016 Introduction A part of the Federal Balanced Budget Act of 1997 required HCFA (now CMS)
More informationAcromioclavicular Joint Billing
Acromioclavicular Joint Billing October 27, 2016 When our physician performs an injection into the acromioclavicular (AC) joint of a patient in the office, can we bill 20610 for a large joint arthrocentesis?
More informationHC 1930 HC 1930 ICD-9-CM III/CPT Coding II
South Central College HC 1930 HC 1930 ICD-9-CM III/CPT Coding II Course Information Description Total Credits 4.00 Total Hours 80.00 Types of Instruction This course is a continuation of HC 1920, 1925,
More informationTwo Midnight Rule What does it mean for Coders?
Two Midnight Rule What does it mean for Coders? Heather Greene, MBA, RHIA, CPC, CPMA Vice President, Compliance Services AHIMA Approved ICD-10 CM/PCS Trainer 1 Agenda The Two-Midnight Rule Supportive documentation
More informationReimbursement Policy. Subject: Consultations. Committee Approval Obtained: Section: Evaluation and 07/01/17. Effective Date:
Subject: Consultations https://providers.amerigroup.com Reimbursement Policy Effective Date: Committee Approval Obtained: Section: Evaluation and 07/01/17 06/06/16 Management *****The most current version
More informationEMTALA. Mark Reiter MD MBA FAAEM
EMTALA Mark Reiter MD MBA FAAEM Residency Director, U. Tennessee Murfreesboro/Nashville Past President, American Academy of Emergency Medicine CEO, Emergency Excellence Objective To educate on EMTALA using
More informationApril 1, 2009 GENERAL PREAMBLE
1. This Payment Schedule identifies the amounts prescribed as payable and rules and conditions of payment under the Physicians and Fee Regulations (Schedule A), governed by the Medical Care Insurance Act
More informationGuidelines for Supervising Residents Updated July 2017
NORTHWESTERN UNIVERSITY FEINBERG SCHOOL OF MEDICINE DEPARTMENT OF SURGERY POLICIES & PROCEDURES Guidelines for Supervising Residents Updated July 2017 PURPOSE To clearly define the level of patient care
More informationDepartment of Colorectal Surgery Pilonidal Sinus Operation
What is a pilonidal sinus? Department of Colorectal Surgery Pilonidal Sinus Operation A pilonidal sinus is an inflamed sinus tract (or tracts, as there can be more than one) which leads to a cavity under
More informationPreventive and Sick Visits Same Day. Objectives
Preventive and Sick Visits Same Day Brenda Chidester-Palmer CPC, CPC-I, CEMC, CCS-P AAPC National Conference June 8, 2010 Nashville, Tennessee Objectives Preventive visit definition Services included in
More informationWilliam J. Ennis D.O.,MBA University of Illinois at Chicago Professor Clinical Surgery, Chief Section wound healing and tissue repair
William J. Ennis D.O.,MBA University of Illinois at Chicago Professor Clinical Surgery, Chief Section wound healing and tissue repair What are the revenue streams What are the expenses How does the hospital
More informationCERNER MILLENNIUM Clinic Billing Workflow (especially for Primary Care Residents)
CERNER MILLENNIUM Clinic Billing Workflow (especially for Primary Care Residents) In primary care resident clinics, where patients are scheduled with the resident & not the attending, this is the workflow
More informationProvider-Based RHC Billing June 8, 2018
Provider-Based RHC Billing June 8, 2018 Sharon Shover, CPC, CEMC 502.992.3511 Provider-Based RHC Billing Agenda RHC Encounters Payment for RHC Services Same Day Visits Revenue Codes CG Modifier & QVL Non-RHC
More informationMid-Level Providers: What You Need to Know to Use Them Successfully in Your Practice
Mid-Level Providers: What You Need to Know to Use Them Successfully in Your Practice Presented by Sarah Reed, BSE. CPC Senior Managing Consultant Medical Revenue Solutions, LLC AAPC 2016 Disclaimer The
More informationJuly 2011 Quarterly CMS OCCB Q&As
July 2011 Quarterly CMS OCCB Q&As Category 1 - Applicability Face-to-Face Question 1: If the F2F does not occur within 30 days, but it does occur, for example, on the 35th day, does the agency have to
More informationNEXTGEN E&M CODING DEMONSTRATION
NEXTGEN E&M CODING DEMONSTRATION This demonstration reviews usage of the E&M Coding template. Details of the workflow will likely vary somewhat among departments, though this should give you a good idea
More informationWhen is it Appropriate to Report During Immunization Administration? American Academy of Pediatrics Committee on Coding and Nomenclature
When is it Appropriate to Report 99211 During Immunization Administration? American Academy of Pediatrics Committee on Coding and Nomenclature ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
More informationPACES Station 2: HISTORY TAKING
INFORMATION FOR THE CANDIDATE Patient details: Your role: Presenting complaint: Mr John Davidson, a 25-year-old man You are the doctor in the medical admissions unit Fever Please read the letter printed
More informationNEW YORK STATE MEDICAID PROGRAM NURSE PRACTITIONER PROCEDURE CODES
NEW YORK STATE MEDICAID PROGRAM NURSE PRACTITIONER PROCEDURE CODES Table of Contents Contents GENERAL INFORMATION... 3 PRACTITIONER SERVICES PROVIDED IN ARTICLE 28 FACILITIES... 5 MMIS MODIFIERS... 5 MEDICINE
More information