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In the quarterly update to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS), a new HCPCS Level II code is being added for anemia management with an effective date of July 1, 2019. J1444 Injection, ferric pyrophosphate citrate powder, 0.1 mg of iron This code is subject to Medicare Part B consolidated billing and, […]
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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!
It’s that exhilarating time of the year! HEALTHCON is almost upon us with opportunities to expand our knowledge and careers. Many officers attending HEALTHCON come back and wish to share what they have learned with their chapter members. This is exciting information and AAPC encourages our conference attendees to give a review of the information […]
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A split or shared visit occurs when both a physician and a qualified non-physician practitioner (NPP) meet face-to-face with a Medicare patient on the same date of service, and the work of the physician and the NPP are “combined” into a single E/M service. Split or shared visits may improve a physician’s productivity and positively […]
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Anugu Srinivas
Medical Coder
Bachelor of pharmacy,CCS
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Anugu Srinivas
Medical Coder
Bachelor of pharmacy,CCS
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:confused::confused::confused:
When reporting for our physician (Provider A) I will report the claim for surgery with modifier 54 on the first line.
When reporting for our physician (Provider A) I will report the claim for post op care on a second line with the proper date span on line 2 of the claim with modifier 55.
Here is my question:
Must I wait till the ending date of our post operative care provided by our physician (Provider A) is complete before submitting my claim? And, can I send two separate claims for the surgery and post operative care or must the claim have both items reported on the same claim which would mean Provider A should wait to submit his claim till he has transferred care to Provider B?
Your help is greatly appreciated!
Should it be: 92273 TC dos 12-10-18 for the technical component
92273 26 dos 12-13-18 for the professional component with written report signed & dated 12-13-18
or is it appropriate to bill: 99273 dos 12-10-18 for the total component with written report indicating this was the reading for the procedure done 12-10-18 being signed & dated 12-13-18
Do I need to send separate claims because the technical component and the professional component were provided on different dates?
Thank you!:rolleyes:
When reporting for our physician (Provider A) I will report the claim for surgery with modifier 54 on the first line.
When reporting for our physician (Provider A) I will report the claim for post op care on a second line with the proper date span on line 2 of the claim with modifier 55.
Here is my question:
Must I wait till the ending date of our post operative care provided by our physician (Provider A) is complete before submitting my claim? And, can I send two separate claims for the surgery and post operative care or must the claim have both items reported on the same claim which would mean Provider A should wait to submit his claim till he has transferred care to Provider B?
Your help is greatly appreciated!
If you’re interested in improving your hospice’s quality reporting, the December 13 webinar, “Update to Public reporting in Fiscal Year 2019: Hospice Comprehensive Assessment Measure and Data Correction Deadlines” is just right for you. Hospice Webinar The Centers for Medicare & Medicaid Services (CMS) will host the two-part webinar covering two different topics for hospice […]
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