Deconstructing diagnostic categories and disease levels.
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Tag Archives: levels
How To Code E/M Levels with Confidence
Don’t let insufficient documentation lead you astray. How many times has a provider asked you, “What do I need to document to get a 99215?” All too often, medical coders feel they should help their providers understand what elements of documentation are needed to warrant the higher level evaluation and management (E/M) service. Do not […]
The post How To Code E/M Levels with Confidence appeared first on AAPC Knowledge Center.
Is this illegal ? Beefing up E/M levels for RVU’s??
As part of the new process at our facility we are required to tell the provider that the level they have selected will be down or up coded to match the documentation.
Now what is happening is the doctor(s) are coming back and saying they will add more documentation after the fact so they can receive a higher level or the one
the originally selected. This feels wrong since the motivation is ($ $ $ ) RVU’s. Upper management doesn’t think anything is wrong with this. Am I over reacting here or does
anyone else see a problem with this?? If you agree with me please if you have anything that I can show as proof I would greatly appreciate it!
Now what is happening is the doctor(s) are coming back and saying they will add more documentation after the fact so they can receive a higher level or the one
the originally selected. This feels wrong since the motivation is ($ $ $ ) RVU’s. Upper management doesn’t think anything is wrong with this. Am I over reacting here or does
anyone else see a problem with this?? If you agree with me please if you have anything that I can show as proof I would greatly appreciate it!
TFESI Levels
One of my docs performed a lumbar TFESI at the RT L3 and LT S1. Would this be coded as 64483-RT, 64483-LT or 64483-RT, 64484-LT.
Any input would be great..
Thanks in advance
Nerve block spanning thoracic and lumbar levels
We are having a debate in the office and I was hoping to find some assistance here.
If a facet nerve block (64490-64495) or ablation spans two spinal regions, since the description in the additional level CPT codes indicate the regions (ie 64491-64492 indicate cervical or thoracic and 64494-64495 indicate lumbar or sacral), does that mean, you would jump to the primary code of the next spinal region for the additional levels?
For example, T11-L2 facet nerve block. Would it be 64490 for T11-12, 64491 for T12-L1, & 64493 for L1-2 or should the L1-2 be coded as 64492?
The only guideline I can find is in the NCCI where it talks about procedures done at contiguous spine levels but it mentions if the additional level code doesnt indicate the spine region that you would use the add on code rather than another primary code.
Thanks!
Adjusting Coumadin levels
We have a couple of patients who are living in nursing homes. They do their INR check there and call us to adjust their Coumadin dosages. Can we bill for those over the phone adjustments?
We have never billed them and have always provided them free but just curious if there’s a code we could use?
Spine levels
Happy New Year!!!
Can someone clarify how many levels of the spine there are, and if they’re counted separately or as 1. For example C3-C4. One or two levels? L5-S1. One or two levels? I’ve always known them to be separate levels but when I researched on Google, it’s showing as a combination. When did this change?
Thanks
E/M Levels 4, 5, 6
When is it appropriate to code a level 4, 5 or 6 for a hospital patient, both Observation and Inpatient? Is it only upon discharge, whether same day from observation or discharge from inpatient? Can these levels ever be coded for subsequent hospital visits while still inpatient?
Levels 4, 5, 6 coding
When is it appropriate to code a level 4, 5 or 6 for a hospital patient? Is it only upon discharge from observation or inpatient status or can it be used for a subsequent inpatient visit?
Cloned notes-determining follow up levels
I have a Hospitalists that clones (copies and pastes) all his notes despite being told about this. I’m having a battle with myself on how to codes his follow ups. My Managers says to code per documentation which I do. Since his notes are cloned and his template is set for a COMPREHENSIVE exam each time (whether medically necessary or not), his follow ups are scored as level 3’s. But what happens when he adds a paragraph to the top of the cloned note stating patient is improved and goes into detail about that? He then adjusts time spent from 35 or 40 minutes down to 25 or 30 minutes. All of this indicates to me a reduced level. I really struggle as these should be coded as level 2’s even though the rest of the note scores a level 3!
I’m trying to justify scoring these as level 2’s because the E/M guidelines are just that…guidelines. The Medical Necessity just isn’t there to ethically score any higher. But yet………when you have 20 pages cloned from when the patient was in ICU……….what does one do?
I’d surely appreciate any guidance in this.
Thank you.