Uncommon diabetes complications and risk adjustment.
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Tag Archives: Factor
How Telehealth Services Factor Into Risk Adjustment
2020 has proven to be one of the most complex, busiest times in healthcare — in the 21st century, anyway. In January, we were preparing for a new chapter in ICD-10-CM, Chapter 21: Vaping-Related Disorders. On January 30, the World Health Organization announced a Public Health Emergency of International Concern (i.e., pandemic) for coronavirus. In […]
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Help Clinicians Factor Cost into the MIPS Equation
Medical coders and auditors are essential to their employer’s outcome in the Cost performance category. Of the four performance categories in the Merit-based Incentive Payment System (MIPS), — one of two tracks for participation in the Quality Payment Program (QPP) — Cost is the most worrisome because clinicians do not have control over this portion of […]
The post Help Clinicians Factor Cost into the MIPS Equation appeared first on AAPC Knowledge Center.
How to factor additional diagnosis into MDM
How would you factor in additional diagnosis for the MDM that are given in the assessment/plan, when these are not documented in the HPI/Exam of why the patient is coming in? For example, an elderly patient is coming in for knee joint pain and then in the assessment/plan the provider lists Hypertension(refilled meds), Gastroenteritis(wants labs done), Glaucoma(referral given), Diabetes(checks A1C) in addition to the joint pain.
My understanding is that you would not use any of these additional diagnosis to level the MDM, even though for each dx the provider wants more work up done.
I’m looking for feedback on what others are doing when a provider adds additional diagnosis and how the MDM is determined.
Humana denied J7194 Factor IX for non-hemophiliac
Humana continues to denial Factor IX (J7194) for non-hemophiliac patients; however, it is a common treatment for emergent anti-coagulopathy. Has anyone had any success overcoming this denial or perhaps has some tips to try? Thanks!
When time spent counseling is the driving factor for E/M and a procedure is done
I’m hoping someone can advise me on this dilemma
I have a provider who will use time spent counseling as the driving factor for E/M.
Example
Pt her for f/u DM,HTN,Hyperlipidemia etc, ROS HPI PFSH and Exam are comprehensive to detailed ,med changes made counseled on diet ….
However sometimes the patient will request a joint injection or lesion removal during the appt and the procedure is done during the visit
he documents 30 minute appointment with >than 50% face to face etc-99214
adding 20610-50 for bilateral knee injections
Am I wrong in thinking that in that 30 minutes the knees were injected as well ?
I’d like to address this with him ,however I know that this will not be received well so I’m hoping someone can confirm or not whether I’m right or wrong
and if there is any information I can use to support changing
Thany you in advance
Cheri
I have a provider who will use time spent counseling as the driving factor for E/M.
Example
Pt her for f/u DM,HTN,Hyperlipidemia etc, ROS HPI PFSH and Exam are comprehensive to detailed ,med changes made counseled on diet ….
However sometimes the patient will request a joint injection or lesion removal during the appt and the procedure is done during the visit
he documents 30 minute appointment with >than 50% face to face etc-99214
adding 20610-50 for bilateral knee injections
Am I wrong in thinking that in that 30 minutes the knees were injected as well ?
I’d like to address this with him ,however I know that this will not be received well so I’m hoping someone can confirm or not whether I’m right or wrong
and if there is any information I can use to support changing
Thany you in advance
Cheri
TIME factor minimum requuirements
If more than 50% of a visit involves counseling and coordination of care, is 40 minutes spent with patient a 99215?. (assuming details about what the counseling consists of are clearly documented and the total time with over 50% counseling /coordination of care is documented.)
How about 25 total time correctly documented, would that be a level 4?
this regards established patients
Thank you
How about 25 total time correctly documented, would that be a level 4?
this regards established patients
Thank you
Fee Schedule Conversion Factor Rises in 2019
The conversion factor (CF) that is used to determine payments under Medicare Part B will be adjusted upward slightly for 2019, meaning a slight overall rise in payments to providers who accept Medicare patents. The projected change, issued as part of the Physician Fee Schedule and Other Revisions to Part B for CY 2019 proposed […]
AAPC Knowledge Center
Risk factor for Skin Biopsy
Hi,
We are having a debate in our office regarding choosing the Risk Factor for Skin Biopsies. When looking at the RISK table, skin biopsy is found under the Low Risk column. Others are looking to the Moderate risk column, under "Undiagnosed new problem with uncertain prognosis e.g. lump in the breast".
We are having a debate in our office regarding choosing the Risk Factor for Skin Biopsies. When looking at the RISK table, skin biopsy is found under the Low Risk column. Others are looking to the Moderate risk column, under "Undiagnosed new problem with uncertain prognosis e.g. lump in the breast".
For example, Let’s say it is an established patient with a Detailed HPI, EPF exam, with 2 established improved diagnosis with no treatment, and a biopsy of arm to rule out isk-vs bcc.
What risk factor do you chose?
Thank you in advance!
HPI element : Modifying Factor
Does alleviation or aggravation of treatment tried be documented to count against Modifying factor?
Example:
Patient is a 58-year-old Caucasian female with sore throat, headache, chills and fever for past 3 days. Pain is rated as 5/10 on pain scale. Patient is experiencing dull pain. She tried lozenges yesterday.
Per my understanding, HPI elements are Duration, severity, associated symptoms and quality. Please correct me if I am wrong.
My question here is patient has tried lozenges, however, no relief is documented. Can I count this against modifying factor?