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I am trying to confirm if our surgeon can submit both cpt codes 27810 and 27814 done on the same day but different encounters. Pt was seen in ER and closed reduction was performed under conscious sedation. It was discussed with the pt and family since there still was displacement of the medial mallous fragment ORIF would be performed, pt went directly to OR from ER. Please advise and thank you in advance!
Physician billed a 61322 – CPT® Code in category: (Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma)
Shortly thereafter the patient developed an intracranial bleed requiring a return to the OR the same day for a 61313 – CPT® Code in category: (Craniectomy or craniotomy for evacuation of hematoma, supratentorial)
As per coding guidelines these 2 cpt codes cannot be billed together on the same day. Considering the circumstances I advised to bill the charge with a -78 modifier unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the post-operative period and appeal if need be.
Ive been advised to bill 61322 twice with the 76 modifier (Repeat Procedure by Same Physician is used to indicate that a procedure or service was repeated in a separate session on the same day by the same physician) which Im not comfortable in using because the 2nd OP note does not support this code. It does support the bleed CPT 61313.
I’d like others opinions.
PROCEDURE: I identified him, I marked his right knee. He was brought back to the examination room and placed supine on the table. Using an alcohol swab, I sterilized points on the right and left lateral abdomen. I used 10 cc of lidocaine with epinephrine to sterilize these two locations. I then sterilized his entire abdomen with ChloraPrep. He was then sterilely draped out over his abdomen.
Next, two small stab incisions were made on the left and right lateral side of his abdomen. I then used sterile saline with epinephrine to inject into the fatty layer between the skin and the rectus abdominus over his abdomen, left and right side. A total of 180 cc were used on the left and 180 cc on the right. There was lidocaine in this mixture. I then allowed 15 minutes for the lidocaine to work and the fat to separate to some degree with the saline.
Then, using the blunt 14-gauge Lipogems needle, I harvested 180 cc of fat getting 90 cc from the left, 90 cc from the right. He tolerated this portion of the procedure well with no complications. The fat cells were then separated using the filtering system from Lipogems. Serum-type fluid and mature emulsified fat were separated from the immature fat. The mature fat then went through a second filtering process using the metallic marbles to break up the fat. I got a total of 17.5 cc of stem cells with immature fat to inject. In the meantime, Tegaderm and 4x4s were placed over his two small stab incisions and two six-inch ACE wraps were applied around his waist for compression. I then sterilized the anterolateral aspect of his right knee with ChloraPrep. I then injected the 17 cc of stem cells into the right knee. A Band-Aid was placed. He tolerated the procedure well without complication.
DIAGNOSIS: Genu varum, primary osteoarthritis, right knee.
PLAN: I will see the patient back in six weeks for a followup clinical examination, sooner if he is having problems. Discharge instructions were provided. Most importantly, no NSAIDs after this procedure. The patient verbalized understanding
Medical transcription is a clinical process. It is a process wherein an audio format is converted into the text format. The entire process can be explained like this. When a patient goes to see a doctor, he goes there because he is not feeling well. The doctor then asks him certain questions regarding his heath. He also asks him about various health disorders he had in the past and his family history about diseases. Through this the doctor can know what is wrong with the patient. All this information the doctor records in an audio tape which is then converted into a text format so that the doctor can store it properly. This is known as medical transcription. Transcription India is also done in this manner only.
Medical transcription is an allied health profession. It can be carried out by individual doctors, medical institutions, clinics, medical colleges and hospitals. Medical transcription is carried out in various medical fields namely- gynecology, surgery, psychology, neurology and dermatology. It is also important in the physiology and oncology department for maintaining various records of the patients. Transcription India is hence very important in various fields of medicine.
Medical transcription is important for doctors. It helps them remember the vital information about patients and their past illnesses and symptoms.
Medical transcription is done by Medical transcription companies. These companies work on outsourcing. They recruit medical transcriptionists for this. Also because of the latest technological developments, medical transcription is undergoing a lot of change.
Medical Transcription is usually done by a medical transcriptionist. They are usually science graduates who possess certain information about medical terms and terminologies. They should be able to verify and check the numbers. They should have a good amount of knowledge about how to maintain and store documents for future easy reference.
Medical transcriptionist requires certain skills. They have to adept at hand eye coordination. They require fast typing movements; hence they should be very quick. They should be capable of understanding the written and verbal communication. Also they should be very skilled in communicating with others, especially doctors since it is an outsourcing job.
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What can be done about bias in peer review?
by Kym Morrissey, BA, CPHQ, CNMT, RT(N), peer review coordinator at St. Anthony Hospital in Lakewood, Colorado
A number of articles have been written about bias in peer review?what it is, how it affects the overall peer review process, and types of bias, to name a few. Bias is understandably the stumbling block to effective peer review. It is the one factor that can take a well-meaning committee that is truly focused on improvement and make it appear as if it is practicing sham peer review.
At St. Anthony Hospital, our professional review committee is a multidisciplinary committee that represents the most active specialties of the medical staff; it also has representation from internal medicine and primary care. Over the years, changes to committee scoring have been implemented to help score more fairly and with less bias.
To assess whether these changes have made an impact, we conduct a biannual survey to assess the perception of the peer review committee members. This has been done since 2009. For the past seven years, we have asked the same questions to allow for comparison across time as new members join, old members step down, and efforts toward improvement are implemented. Two questions specifically designed to assess bias have consistently been included in the survey:
The results of those two questions reflect improvements that have been made and the impact of those improvements on our survey results. (See the chart at bottom-left.)
In 2010, multi-level scoring was implemented but included patient outcome, which inherently biases the case review, particularly if the outcome isn’t good. In 2012, the committee moved to a multilevel scoring system where overall practitioner care, issue identification, and documentation comprised the final case assessment. The perception of bias is slowly improving with the change to the multi-level scoring.
In 2013, one of the committee members suggested blind voting to increase members’ ability to vote with their conscience without the pressure of a show of hands. Initially this was done with a voting sheet, and the scores were tallied and reported during the meeting, but this method proved too onerous. The committee then started utilizing an audience response system to allow the members to vote privately. The voting results are displayed immediately so that the members are aware of the case level assessment.
It has been interesting to watch the voting reflect the opinions of the members. Previously a show of hands would be unanimous; it would be difficult to say that members were voting according to their conscience. Group pressure would prevail, and hands would go up as members looked around the table. With an audience response system, the results are more telling?rarely is there a unanimous vote. A simple majority determines the level assigned. In the case of a tie, the committee may discuss a few of the salient points again and then revote the question. The voting results are displayed immediately so that the members are aware of the case level assessment.
In reviewing the survey, the 2014 results marked the first time a unanimous response was registered to the question of whether the actions taken by the committee were appropriate. From a low of 41% in 2011 to 100% in 2014, we may say that anonymous voting has given the committee the freedom to vote truthfully and the peace of mind that actions are appropriate. The verbatim comments from the most recent survey of peer review committee members bear this out:
In summary, from much of the literature that exists on professional peer review, there is a general opinion that bias is one of its inherent enemies. Even small attempts to reduce bias can add value. Will we ever be able to overcome all bias? In all honesty, no, but we should not give up the battle to reduce it.