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Any advice or suggestions?
Thank you,
Sabrina Fox, CPC, CCA
A patient underwent an incision and drainage procedure at our facility. According to the operative report, an incision was made over the lesion and purulent material was expressed. Loculations were broken up using forceps and more of the material was expressed. The drainage cavity was then irrigated, packed and dressed with sterile gauze.
Would it be appropriate to code an incision and drainage (I&D) as complicated based on documentation that a drain or packing was used? There are many articles available that provide varying opinions and we would appreciate an official response. Should the term complicated be documented or may the coder use the drain or packing as an indicator of a complicated procedure?
ANSWER
No, it would be inappropriate for the coder to assume that the incision and drainage is complicated based on the use of a drain or packing without confirmation from the physician. When the documentation is unclear the coder should query the physician for clarification.
With that said my question is- If I’m not basing a complex I&D on whether the provider used packing or a drain, can use the fact that they probed for loculations, or explored the abscess further to come to a 10061(complex; multiple) for a more complex procedure? I’m asking in the absence of a query would probing and/or breaking up loculations be evidence of a complex I&D? According to the coding clinic we just can’t assume placement of a wick or drain is evidence of the complexity but it says nothing about probing, or breaking anything up shouldn’t be used to determine the complexity. I know it’s at the discretion of the provider, but unless they state it was complex OR if there was more than one abscess then what other indication is there to code a 10061 for the (complicated;multiple except for the obvious more than one)?
Do we call everything a simple I&D unless the provider states it’s complex?
Thank you!
Thank you.
Blackhorse, CPC-A
At first we were billing 99213 with place of service 22 – now I’m being told that is not the correct code. I’m so confused and have no idea what to bill or how to bill it.
Help!!!!!
Let’s accept that no one ever plans to be sick. Well…almost, except after the forecast of a sunny Friday afternoon following a gruelling week. So what options do you have when you wake up with a sore throat or a fever that refuses to go away? Local Primary Care Physicians are booked up weeks ahead in the season of cold and flu and nothing could be sworse than walking into an emergency room with a running nose sore throat and a cough. Sitting for hours in a waiting room to see a doctor when you are feeling sick is nothing short of a punishment. Only option is to choose between toughing it out by burying your head under covers with a steaming cup of chicken soup or visiting the nearest walk in clinic
Walk in clinic offers brilliant solution when your condition is not life threatening but still demands immediate medical attention, without long wait and inconvenience of a hospital. Walkin clinic of Manhattan provide similar services as offered by hospitals and emergency rooms with minimum waiting period and far less expense.. You can just schedule same day appointment and walk into a walkin clinic and see the doctor. No wonder most people now prefer walk in clinic for unexpected illnesses and minor injuries.
Walk in Clinic of NYC is a same day appointment medical facility that provides a gamut of services including treating acute conditions, follow up and preventative care services. Sinus infections, cold and flu, allergies sore throats, migraines, sprains, bronchitis, ear infections and minor burns and cuts are some of the ailments which are treated at Walk In Clinic of NYC. Health screenings, physical examinations and vaccinations available at walk in clinic that help in preventing sickness in the future.
Centrally located in midtown Manhattan, Walk In Clinic of NYC ensures prompt medical services at reasonable rates for those who has no insurance, otherwise most insurances accepted. With provision of same day appointments you don’t have to wait for long hours. You can also get prescription and medication refills in case you are unable to reach your doctor. When you schedule an appointment before visiting Walk In Clinic of NYC, it minimises the waiting time and guarantees a relaxing visit.
Resource box
To know more about various services offered by walk in clinic of NYC, logon to http://www.walkinclinicnyc.com/
The practice of medicine is a profession that will not run out of clients. It’s because our body isn’t invincible. Time and time again, he is bound to contract some form of disease and he is going to need a doctor. Let us discuss how to start a medical clinic business.
First of all, you need to have a business plan. The plan should include a business goal, some reason that the business should work, and a phase-by-phase plan on how to achieve the goal.
Next on the list is the capital. Without initial capital, no business can be made possible. You might need to apply for a bank loan. In such a case, you are going to incur an accounts payable. A short-term accounts payable is expected to be resolved in one operation cycle which is one year. Whereas a long-term accounts payable takes more than a year, about two years, to pay off.
Then you have to find a suitable location for your medical clinic. Let’s just assume that you are a medical doctor, you should already have a small clientele that you have built from your years as a medical resident. Location should be somewhere in the business section of the city or town with accessibility to buses or subway trains.
By the time you have found a suitable location, you should have an architect or interior designer plan the layout of your clinic. Your clinic should have a reception area where theres a counter for the receptionist. Equipment that the receptionist needs are a computer unit, Adjacent to it is the waiting area where patients wait for their turn. There should be furniture for sitting, a TV set or some reading materials so the patients dont get bored while waiting. A toilet should also be provided, either unisex or one for each sex.
Depending on the number of doctors, so should there be the same number of offices. There should be two or three treatment rooms. You should make a deal with medical equipment manufacturers to get a good deal on EEG machines, ECG machines, EKG machines, ultrasound machines, weighing scales, etc. They could offer you short-term or long-term accounts payable services. A vending machine can also be put up in the waiting area so that patients could have refreshments to tide over the wait. Make sure you have provisions for parking.
This is no different for a business intending to market their products to another business. Sales and marketing both have something in common: they’re both dependent on the right contacts. If you don’t have the right contacts to sell your products or services to, then your revenue streams will be stagnant at zero. Nothing gets marketed, nothing gets sold. On the flipside, you spend your resources marketing a product, but to the wrong target audience. Something gets marketed, but nothing gets sold, which eats away at your profit margin or even break-even point.
So you see, even as a business you need a proper and highly targeted list, if you’re in an industry that deals majorly in medical equipment or pharmaceuticals or anything medical related that can be of use to a medical clinic, then you must have a qualified list of medical clinics in order for you to do business.
Come visit us and we’ll teach you everything you need to know about account payables, from accounts payable automation to accounts payable jobs.
Related Medical Coding Articles
A former employee of Portland, Oregon-based Northwest Primary Care (NWPC) allegedly stole the personal information of 5,372 patients. The employee accessed this information between April and December 2013, according to a statement released by NWPC. The incident went undetected for two years until law enforcement informed NWPC of the theft on October 13, 2015. NWPC notified the public on December 11, 2015. The former employee accessed patients’:
There is no evidence that the employee used or attempted to use the information, NWPC says. However, NWPC is offering affected patients identity theft protection services including identity recovery services, 12 months of credit monitoring, and a $ 1,000,000 insurance policy.
Reference and background checks are performed on all employees, and employees who work in highly sensitive positions, such as working with patient financial data, undergo additional background checks, NWPC says. Existing policies, procedures, and the employee code of conduct contain guidelines for accessing PHI and prohibit employees from inappropriately accessing or using PHI. NWPC is increasing its technology monitoring and employee training on accessing patient records in response to this incident. Additional technical safeguards will also be implemented to further protect PHI from theft or other criminal activity.
See below the reasoning why we have been told to bill with the 26 modifier when the physician assistant sees and reads the images.
The policy is in place because:
1) We do not have actual orders in our system, x-rays are done by verbal orders. If the PA is seeing the patient, they are technically ordering unless ordered by the physician in their dictation prior to.
2) PAs under Medicare, MPB Ch. 80, are not eligible to supervise x-rays done by an x-ray tech. If there is no documentation of physician involvement in the treatment that day then we cant bill the x-ray under the physician.
3) We did try to bill the TC under the physician in some cases, but again, due to no actual order in place, we didnt have documentation to back it up (This is supposedly being addressed by Nick, our IT director)
So the decision was until we have a system in place to be able to provide some actual documentation of the order of the x-ray being ordered by the doctor that it would be billed under the interpreting provider, for some docs, if they are in clinic then they are dictating their own interpretation and we should be billing the x-ray under them. Please forward this to your contact and see what she thinks. This came from an attorney who did a compliance course, If you want to change it you will need to address it with Star and it may need to go back to the doctors.
If the supervising physician is not present to supervise the PA, and the PA is not eligible to supervise the technician who performed it, then what is your suggestion.
See below the reasoning why we have been told to bill with the 26 modifier when the physician assistant sees and reads the images.
The policy is in place because:
1) We do not have actual orders in our system, x-rays are done by verbal orders. If the PA is seeing the patient, they are technically ordering unless ordered by the physician in their dictation prior to.
2) PAs under Medicare, MPB Ch. 80, are not eligible to supervise x-rays done by an x-ray tech. If there is no documentation of physician involvement in the treatment that day then we cant bill the x-ray under the physician.
3) We did try to bill the TC under the physician in some cases, but again, due to no actual order in place, we didnt have documentation to back it up (This is supposedly being addressed by Nick, our IT director)
So the decision was until we have a system in place to be able to provide some actual documentation of the order of the x-ray being ordered by the doctor that it would be billed under the interpreting provider, for some docs, if they are in clinic then they are dictating their own interpretation and we should be billing the x-ray under them. Please forward this to your contact and see what she thinks. This came from an attorney who did a compliance course, If you want to change it you will need to address it with Star and it may need to go back to the doctors.
If the supervising physician is not present to supervise the PA, and the PA is not eligible to supervise the technician who performed it, then what is your suggestion.
Posted for Member by Midtown OKC Chapter