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Tag Archives: Days
Reporting NSTEMI Type 2 27 days paging mitchellde
Hi everyone,
I have an interesting case needing your opinion.
Patient had knee replacement surgery and post surgery complained of chest pain. Tests revealed elevated troponins which physician classified as NSTEMI. Upon further diagnostic testing, it was revealed it was a Type 2 NSTEMI which medically means as explained to me elevated troponins due to imbalanced oxygen demand and supply, not due to plaque rupture and can be caused by arrhythmia, hypotension, sepsis, etc.
Therefore, hospital stay was coded as I21.4.
Patient came back to the clinic 27 days after initial diagnosis. Coder said that per coding guidelines, within 28 days the NSTEMI must be coded as such and must "follow" and be documented in the clinic post hospital follow up.
The doctor felt that since the NSTEMI is a Type 2 and not caused by CAD, he did not document the NSTEMI. His reason is that it was a transient diagnosis during the hospital stay and not an active diagnosis during office visit. His reluctance to mention NSTEMI is because he said if it is in the documentation, other providers might not understand the complexities of different types of NSTEMI and recommend the patient to have procedures that might harm the patient.
Coder came back insisting that we will be "flagged" and NSTEMI coding is strict. She attended one of your seminars and she wants to hear it from you. I attended several of your seminars and the gist is that as long as the physician is documenting it and able to defend his notes. Her suggestion is for the physician to go back and change his notes to suit the coding guidelines, which no physician would agree to in our group.
I understand that as coders we need to adhere to the coding guidelines but in the real world it is the patient’s wellness and welfare we need to prioritize when it comes down to documentation and communication.
Can somebody please explain to how not coding NSTEMI through all subsequent visits will be flagged. Our notes are very extensive and well supports the diagnosis, compared to other physicians in our small town.
Thanks!
Surgery global days
I have a patient that was seen in the ER for RUQ pain and abnormal finding on CT. The patient was admitted to the hospitalist. The hospitalist ordered a consult with the Surgeon. The patient was seen and decided to see if the patient improves. The next day the patient was seen and the decision was made to do surgery. I realize there is a 90 day global period starting the day before surgery. My question is can I bill the visit the day before surgery if it was prior to the decision made to do surgery.
I billed the following:
11/23/18 99225 (this visit is being denied) Would this still be considered inclusive?
11/24/18 99225-57
11/24/18 44970
Cpt 90870 – ect – global days?
Hello,
UHC Medicare is denying an E/M billed days AFTER the DOS of a ECT, stating "per UHC-Medicare, they stated that according to Medicare, ECT have a 90 days global". Does anyone has any information they can share on this? I’ve searched on the Medicare website and I cannot find anything. I also checked on EncoderPro and the code has no global days. Any information is appreciated. Thanks
GreenLight 65 days post-TURP?
I just want to make sure this is correct coding.
Patient had a TURP 65 days ago. Came back and had what the doctor dictates as a "Greenlight laser" for hematuria. The dictation reads like this:
"#25 French continuous flow resectoscope was inserted through the mid urethra and past a well resected prostate into the bladder. There was no evidence of stone or tumor and the orifices were normal. No active bleeding was noted in the prostate or bladder currently. A small strand of tissue was seen hanging off of the left sidewall of the prostate into the lumen so this was treated with laser. The entire surface of the prostatic urethra was then treated using the coag setting on the laser."
I’m thinking this is a 52647 with modifier 58.
Yes?
Follow up renal Ultrasound on 40 days old infant
Hi, I got a situation here and hope I can get a solution through this forum. Reposting in diagnosis section
A 40 day old infant was ordered a Renal ultrasound as a follow up on her abnormal prenatal US as they showed kidney dilation. We got a denial as we used O28.3 which should go on mothers records but not on an infant’s. Of course, we realized after the denial. The new born does not show any signs or symptoms to reorder this US for us to code and the intention is purely for re screening as per the order.
P.S- P09_Abnormal findings on neonatal screening was actually coded on the initial birth claim.
What would be appropriate diagnosis code to code in this scenario. Thank you!
A 40 day old infant was ordered a Renal ultrasound as a follow up on her abnormal prenatal US as they showed kidney dilation. We got a denial as we used O28.3 which should go on mothers records but not on an infant’s. Of course, we realized after the denial. The new born does not show any signs or symptoms to reorder this US for us to code and the intention is purely for re screening as per the order.
P.S- P09_Abnormal findings on neonatal screening was actually coded on the initial birth claim.
What would be appropriate diagnosis code to code in this scenario. Thank you!
Followup renal Ultrasound on 40 days old infant
Hi, I got a situation here and hope I can get a solution through this forum.
A 40 day old infant was ordered a Renal ultrasound as a followup on her abnormal prenatal US as they showed kidney dilation. We got a denial as we used O28.3 which should go on mothers records but not on an infant’s. Of course, we realized after the denial. The new born does not show any signs or symptoms to reorder this US for us to code and the intention is purely for re screening as per the order.
P.S- P09_Abnormal findings on neonatal screening was actually coded on the initial birth claim. What would be appropriate diagnosis code to code in this scenario. Thank you!
A 40 day old infant was ordered a Renal ultrasound as a followup on her abnormal prenatal US as they showed kidney dilation. We got a denial as we used O28.3 which should go on mothers records but not on an infant’s. Of course, we realized after the denial. The new born does not show any signs or symptoms to reorder this US for us to code and the intention is purely for re screening as per the order.
P.S- P09_Abnormal findings on neonatal screening was actually coded on the initial birth claim. What would be appropriate diagnosis code to code in this scenario. Thank you!
MDM (tests contemplated at OV, but not decided until days following OV)
I have a CNP who billed an office visit on 4/4/18 and told the patient that if his (chest pain) symptoms progressed, he should return and a stress test would be performed. The patient called back 8 days later and the CNP ordered the nuclear stress test. An addendum was made to the 4/14/18 note. Can the stress test be used to achieve a higher level of service for the 4/4/18 encounter?
Summary of encounter: Patient had increasing angina. Progressive symptoms were discussed with the interventional cardiologist. It was decided that the patient should continue to maximize medical therapy. "We will have the patient return for stress testing if his symptoms do not improve." The patent called the CNP on 4/12/18 and noted no improvement in his symptoms. A myoview stress test was ordered for the next day. Can the plan for the myoview stress test be counted in the MDM for 4/4/18, or because the "final decision" for it was not made until 8 days after the face-to-face encounter, does it not count toward the level on 4/14/18?
Pam Schmitt, RHIA, CCS, CCS-P, CPC
Billing out if CRCS not done in 30 days
We have some patients come into the office and see a mid-level provider and decide to do their screening colon. We hold onto the claim until after they are seen, and then mark it as inclusive to the screening colonoscopy done, with a zero fee. Then we have other patients who come in, hem and haw about getting a colonoscopy done, and after holding it the 30 days we bill them out. I do not believe this is the correct way to go about this (these are traditional Medicare patients I am speaking of). I know we do not bill the patient if Medicare denies, so we end up eating the cost. My issue is that the facility side is paid but not the professional side. We have nothing else to code except the Z12.11 because they ARE symptomatic and just coming in as a pre-colonoscopy visit. What are others doing with regards to this type of visit?
Anesthesia preop eval some days before the procedure
We are about to bill for a new group… who seem to think we can bill an e/m for the standard preop eval if it was done over 72 hours before the procedure.. as a standard practice. I said absolutely not.. to me that Is outright unbundling. Because the visit would be the pre anesthesia eval and not done for a separate unrelated illness. Just had to share this silliness.