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Tag Archives: clarify

Please help clarify HCPCS code G9008

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Looking for a more specific description for HCPCS level II code G9008- My provider has been told he can bill this code when our NP does follow up calls on patients
that were seen either in ER or urgent care. Example: Patient seen in ER for broken bone, we receive notice that patient was seen in ER we call (document that patient was called) to see how they are doing patient tells us what happened and that ER sent them to see Orthopedics and when they have follow up appointment with Orthopedics scheduled. I’m not sure where our "Coordinated care oversight services" really are?? Would someone please help me to determine if this really is proper coding and where I might be able to find documentation? Thank you!

Medical Billing and Coding Forum

Telemedicine – can someone clarify?

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Forgive me if this question has been asked already, I couldn’t find anything definitive. I have never worked for a practice that’s even entertained the idea of telemedicine, so it’s brand new to me. :)

Everything I’m reading on telemedicine (from Medicare and Medicaid) indicates that it’s primarily for "underserved rural areas". Does this mean that it’s for when a patient is in a hospital or PCP office in the middle of nowhere and needs a specialist to consult on their case and that’s how the specialist is brought in rather than one of them having to make the trip to wherever? Or if the doctor is on call for a local facility and gets "dialed in" (for lack of a better term) rather than rushing over to the hospital? Or is it for a patient after hours who has a minor ailment that can be addressed without making them wait for the next business day to physically come into the office?

I would imagine that in the the instance of the first two scenarios, all the elements of the E&M could be hit because it’d be almost a collaborative effort, right? (the practitioner who’s physically with the patient does the exam) But in the last scenario – the after hours patient – it really could never be higher than a 99213 because it would be a limited physical exam.

Do I have the right idea on this or am I not even in the right ballpark?

Thanks!

Medical Billing and Coding Forum

CMS and Joint Commission clarify door-closing devices standards

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 Examine all automatic door arrangements in light of the newest clarification on fire doors from CMS and revisions to The Joint Commission’s Life Safety standard on providing building features to protect against fire and smoke hazards.

HCPro.com – Briefings on Accreditation and Quality

Please Clarify

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Hi!

I’m creating some coding FAQs for dentist who are participating Medicare DME suppliers. They provide Oral appliance therapy for OSA. They have been told after the initial 90 day delivery of the DME device, they should bill Medicare Part B for follow-up visits. I think that’s incorrect because Medicare doesn’t recognize dentist as MDs and Medicare also doesn’t cover dental visits.

Can someone clarify that an DDS/DMD can not bill CPT e/m services to Medicare?

Thank you in advance!

Tiffany

Medical Billing and Coding Forum

clarify addendums vs timeliness

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If ER physician did not document an exam or HPI (I know that is a problem), would it be appropriate to send the physician a query to add a late entry/addendum? This would occur the next day not weeks later.

I’ve look at several links and have tried to find solid information on this. All the information I find is about timeliness. The ER charts are locked after 48 hours here at our facility but it does not address the issue of sending queries.

One person in management says, "due to missing physician documentation we cannot query for additional information in order to assign a higher level. CMS considers this leading." How is it leading if I am asking the doctor to complete the documentation? I am not leading, merely stating—Dr. ???? in your ER note you are missing documentation on ????. ( the physician has not documented anything for the portion I am querying.) I would not send a query even if the physician put one element.

How would the 3.3.2.5-Amendments, Corrections and Delayed Entries in Medical Documentation be implemented then?
https://www.cms.gov/Regulations-and-…s/pim83c03.pdf

I’ve asked other coders and there reaction is, "it is not leading to ask them to complete the documentation."

In addition, in one of AAPC’s training programs it is stated, "An addendum to include information about what was done to the patient, or any test results, should be added within a reasonable time frame, usually capped at a maximum of 60 days after the encounter."

Please tell me what you think. The new management does not provide information to clarify there statement.

Medical Billing and Coding Forum

Coding & Billing: Clarify ‘Present & Immediately Available’

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‘Physically present and available’ can be one of the most difficult factors to determine when confirming medical direction. You should keep these guides in mind when deciding whether your anesthesiologist’s claim still merits medical direction modifiers QY or QK.

Think about individual circumstances

Vague medical direction rules like ‘remains physically present and available for immediate diagnosis and treatment of emergencies’ allow for individual interpretation.

Defining ‘immediately available’ accurately is more than looking at the hospital’s blueprints to see how far your physician walks down the hall. Interpretation also takes each situation into account. For instance, the anesthesiologist needs to be more easily available to help during an emergency when he is medically directing an aneurysm repair versus a hernia repair.

Think about these three factors when trying to determine what qualifies as ‘physically present and available’ in your hospital.

OR Size:

Service location:

Patient condition:

Key determinant: Think how quickly the anesthesiologist could help the medically directed CRNA in the event of an emergency. If the anesthesiologist is away from the OR suite or outside the surgery department, is he ‘immediately available’ to return if required? If so, his work might still fit under the medical direction umbrella; if not, you might need to rethink his status.

Know how the factors impact coding & billing

The factors listed above will not change your code for the procedure itself, however can change the anesthesiologist’s performance modifier and his reimbursement. If the anesthesiologist personally carries out a case, you know where he is for the entire procedure and report modifier AA with the procedure code. The carrier shells out money for the entire case.

Coding gets tougher when the anesthesiologist oversees other members of the team rather than personally performs cases. If he medically directs one CRNA, report modifier QY with the procedure code; if he directs from two to four anesthetists, report modifier QK instead. Doctors who medically direct cases split the procedure fee with the other anesthetist involved.

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