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1997 Guidelines for Specialty Eye Exam – Is dilation required?

Posted on April 28, 2017 by CPC Exam Medical Coding Updates

Hi There,

I’m trying to figure out whether dilation is required for a comprehensive eye examination to be coded. There is new technology out there that allows an optometrist to view the optic discs, retina, & vitreous bodies without having to use drops to dilate the pupil. However, according the 1997 guidelines, these areas of the eye must be "through dilated pupils (unless contraindicated)." This information can be found on the CMS website here:
https://www.cms.gov/Outreach-and-Edu…eferenceii.pdf

I have been trying to see if these guidelines have been updated, without luck. There is an AAPC article that states the dilated exam is optional (https://www.aapc.com/blog/30462-spli…ye-exam-or-em/), but to me, you cannot get a comprehensive examination if it is not done (comprehensive is defined as "perform[ing] all elements identified by a bullet; document[ing] every element in each box with a shaded border and at least one element in each box with an unshaded border".

If anyone has additional information that could pass along, or if they have experience with the new technology that I described above & how to document it, I’d really appreciate any help I can get!

Medical Billing and Coding Forum

License required for everyone that uses CPT codes?

Posted on December 25, 2016 by CPC Exam Medical Coding Updates

Looking for anyone that has heard from their software vendor that every user in the organization (providers, coders, data entry staff, front desk, nursing staff, etc) who use any of the CPT codes is required to have a license from the AMA. We’ve been told that AMA requires everyone to have a license if they have anything to do with any CPT code – all the way from picking a code for billing, to submitting the claims, to ordering tests/procedures, to running reports using the CPT codes. Is this something new? When did it start? Has anyone been audited by AMA? Have been told there’s an initial license fee of approximately $ 275, then an additional fee of $ 35 per user, if you license thru the AMA. Thanks.

Medical Billing and Coding

Home Health Care: Proper Certification Required

Posted on October 4, 2016 by CPC Exam Medical Coding Updates

Originally Published on CMS.gov

The Affordable Care Act requires a physician or a non-physician practitioner to have a face-to-face encounter with the beneficiary before a physician certifies the beneficiary’s eligibility for the home health benefit. One aspect of the certification is for the certifying physician to certify (attest) that the face-to-face encounter occurred and document the date of the encounter. For medical review purposes, Medicare requires documentation in the certifying physician’s medical records and/or the acute/post-acute care facility’s medical records to be used as the basis for certification of patient eligibility. This documentation must include the clinical note or discharge summary for the face-to-face encounter. Avoid home health claims payment denials or improper payment recoveries by understanding Medicare’s requirements.

Resources:

CY 2015 Home Health Prospective Payment System Final Rule
Medicare Benefit Policy Manual, Chapter 7, Section 30.5.1
National Provider Call: Certifying Patients for the Medicare Home Health Benefit

MLN Matters® Articles:

The Medical Management Institute – MMI – Medical Coding News & MMI Updates

Labs required per drug prescribing info

Posted on September 13, 2016 by CPC Exam Medical Coding Updates

Good afternoon. I have a question regarding diagnosis for certain tests that are required for patient’s receiving certain drugs. For example, Opdivo requires thyroid testing. In review of the covered codes for TSH testing, there is no code that would cover testing in this case. Another example would be administering B-12 injections for Alimta. Previously there was an ICD-9 code (V07.39) that stated need for prophylactic chemotherapy. This now transfers to either Z41.8 which is an encounter code or Z79.899 for long term/current drug therapy. In my Opdivo example, the patient has not yet received any chemotherapy, so the Z79.899 would not be valid and Z41.8 is not covered.

Also, I have had problems with commercial carriers when using the Z41.8! Any insight would be fabulous!

Thanks in advance

Rachel Brunswick, CPC, CHONC

Medical Billing and Coding | AAPC Forum

AWV Required elements

Posted on September 1, 2016 by CPC Exam Medical Coding Updates

Hello,
I have a provider who saw a Medicare patient for a routine physical and billed 99397, claim got denied by medicare.
we are not able to use AWV codes due to the physical did not contain all the AWV required elements.
Should the provider recall the patient back to perform the AWV elements and re submit the claim using AWV codes.

Much appreciate your Response !

Thanks

Medical Billing and Coding | AAPC Forum

Documentation required for coding chronic conditions

Posted on August 15, 2016 by CPC Exam Medical Coding Updates

I am in need of clarification of the required documentation to code chronic conditions. If the CC states "F/U" and states "depression symptoms controlled, blood sugars low, HTN" and the plan states "continue on current meds, follow up in 1 month or prn" and includes lab results, can you code depression, DM, and HTN?

I am definitely thinking no, that each condition needs to be assessed and treated in order to code them. Such as "HTN controlled" or "HTN controlled on current medication" and likewise for the DM and depression. I know a coder can not interpret lab results. And as far as the plan goes; should it say something like "continue Metformin for DM" not just "continue current meds"?

I am looking for specific information of what needs to be documented in order to code all the chronic conditions.

I thank you in advance for all information!

Medical Billing and Coding Forum | AAPC

Practice Sample CPC Test Questions to Prepare Yourself For Your Actual Certified Coder Exam and Medical Coding Career

CPC Study Guide and Sample CPC Exam Questions And Answers – Best Way To Prepare For Your Medical Coder Certification Test

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