Laureen shows you her proprietary “Bubbling and Highlighting Technique”
Download your Free copy of my "Medical Coding From Home Ebook" at the top right corner of this page
Beginning this month, nine HIPAA-covered entities — a mix of health plans and clearinghouses — will be randomly selected by the Centers for Medicare & Medicaid Services (CMS) for compliance reviews. Any health plan or clearinghouse — not just those that work with Medicare or Medicaid — may be selected. The CMS Division of National […]
The post CMS Begins Compliance Review Program appeared first on AAPC Knowledge Center.
PRE-OP DX: ischemic ULCER RIGHT LATERAL FOOT
post-op dx: osteomyelitis WITH ISCHEMIC ULCERATION OF RIGHT LATERAL FOOT INVOLVING 4TH AND 5TH METATARSAL AND CUBOID BON
Performed:
1) debridement of right foot to include skin & soft tissue and cuboid bone right foot.
2)Right 5th metatarsal resection, partial
3) right 4th metatarsal resection, partial
Description: (extraction of pertinent verbiage). Ischemic ulceration was then debrided over the lateral foot. This clearly involve the 5th metartarsal bone.
Wound did extend more medially w/involvement of the cuboid bone as well as the 4th metatarsal. These were all sharply debrided back with a rongeur and
the 5th metatarsal was resected along with a portion of the 4th metatarsal. Would was packed w/saline-good bleeding was appreciated from wound bed.
My efforts: I see a debridement here in #1, but not sure about the two codes for #2 and #3. I’m thinking 28122, 28122. (The 5th metatarsal was resected, with a portion
of 4th?), so not sure about choosing the same code for both procedures when one was a partial.
Can anyone offer guidance?
Right out of the gate, Medicare Incentive-based Payment System (MIPS) adjustments were incorrectly applied to nonphysician services and supplies. This error is being corrected by the Centers for Medicare & Medicaid Services (CMS), but what if no one caught it? MIPS eligible clinicians and clinician groups could have improperly lost or gained considerable revenue. This […]
The post Ensure Proper MIPS Payment Adjustments with a Targeted Review appeared first on AAPC Knowledge Center.
Both the 1995 and 1997 Evaluation and Management Documentation Guidelines define a review of systems (ROS) as an account of body systems obtained through a series of questions seeking to spot signs and symptoms that the patient may be experiencing, or has experienced. This query is made by the physician and/or the staffs verbally, or […]
The post Know Review of Systems for More Accurate Coding appeared first on AAPC Knowledge Center.
My doctor is often asked to review records for patients from out of state due to a study he is doing. In the past he has done these for free, but they are taking up enough time that we are now going to implement a charge for these reviews for private insurance patients.
While we fully realize that we cannot do this for Medicare patients, I was wondering if we could use an ABN to notify them of the fact that Medicare will not pay for this review of records and that the patient will be directly responsible for this charge. From my understanding of how ABNs work, an ABN is used to notify the patient of something that might not be covered under Medicare. Am I understanding correctly that we could possibly use the ABN as a way to charge Medicare patients? This would solely be a records review – we would not be seeing the Medicare patients.
I’m not trying to do anything hinky here. Just want to be able to allow Medicare patients to also have their records reviewed because the kind of things we are reviewing for often occurs more in Medicare-aged patients anyway.
I’d appreciate having anyone who’s a Medicare billing and ABN expert weigh in on this.
Julie Veronick, CMPE, CPC
The physician is telling me this: There are other facilities and ED staffing companies that routinely use this statement to indicate that a 10-point ROS has been completed and bill as such. In addition, it is my understanding that ROS may be extracted from the HPI as documented.
Can anyone provide me with some guidelines or documentation verifying the physician needs to document more than All other systems reviewed/neg:YES?
Review of Systems
Review of Systems
All other systems reviewed/neg: Yes
Thank you so much!
Any thoughts?
Thanks,
Cheryl
Bec we are in a rural area and not a lot of specialists here, we see a lot of complex patients. We are getting swamped with request for records from insurances, like 120 from BCBS, 80 from Humana, 50 from Aetna, etc.
We are drowning and had to pull resources to be able to comply with this requests.
I understand that it is in the contract that we should pull the records as requested but i think it’s unfair that the insurances are getting money from the government, and we are doing all the work.
Any thoughts?
Ehler’s-Danlos Syndrome; excessive dynamic airway collapse; hypertrophy of the trachealis and bronchialis muscles
Spasm of muscle [M62.838]Subglottic stenosis [J38.6]
Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia (HCC) [J96.10]
Suspension MicrolaryngoscopyBronchoscopy with Botox injection of trachealis/bronchialis muscles.
Bronchoscopy with CO2 laser scarification of Posterior Bronchial/Tracheal Wall
Anesthesia: General
Estimated Blood Loss: Minimal
Drain: NA
Total IV Fluids: as per anesthesia
Specimens: * No specimens in log *
Implants: * No implants in log *
Complications: 3 mm anterior tongue laceration sustained during exposure with Lindholm scope
Findings:
1) Moderate difficulty with Lindholm scope, placed in suspension
2) Stable tracheal stenosis, minimally obstructive without intervention necessary today
3) Improvement in bulk of trachealis and bronchialis from prior botox and laser procedures, but overall still with some hypertrophy
4) Around 20-25 U botox injected to right and left mainstem bronchus bronchialis muscle each using sclerotherapy needle. Another 50-60 U botox injected to trachealis in multiple locations.
5) Flexible CO2 laser with flexible bronchoscopy used to scar distal posterior tracheal wall and right mainstem posterior bronchial wall (left side left untouched as it appeared less hypertrophied and sufficiently open)
Disposition: awakened from anesthesia, extubated and taken to the recovery room in a stable condition, having suffered no apparent untoward event.
Condition: doing well without problems
Technique: clean, contaminated
Procedure Details: Patient was brought into operating room and turned over to Anesthesia. After timeout was performed, patient was induced under general anesthesia and bag masked with no difficulty. Patient was then turned over to the ENT team, and we performed bag mask ventilation with ease. Mouth guard was put over patient’s maxillary teeth for protection, and the Lindholm scope was then used to expose the larynx with moderate difficulty. The patient was placed in suspension with the Lewis arm. The zero degree hopkins rod was used to visualize the larynx, however, the angle of suspension did not allow for visualization of the trachea. Jet ventilation was initiated through the scope port, but patient’s saturations were not sustained, as such, the patient was intubated with a 5-0 ET tube with no difficulty through the scope. After ventilating sufficiently, tube was taken out, and jet ventilation was reinitiated by extending a catheter below the glottis. The flexible bronchoscope was used to examine the airway. There was persistent stable tracheal stenosis that was only minimally obstructive. As such, no intervention was deemed necessary. The trachealis and bilateral mainstem bronchialis muscles were noted to still be hypertrophied as before, though seemingly less so (particularly the left mainstem bronchus). The previous laser marks were no longer visible in the posterior wall, but there did appear to be a drop off where the laser marks had ended previously (c/w a reduction in bulk of the muscle where laser had been used). After examination, jet ventilation was held, and the ET tube was re-inserted, and the patient was ventilated by Anesthesia. The botox was then prepared to a concentration of 50 U/mL. This was placed in a 5cc syringe attached to a sclerotherapy needle, which was threaded into the flexible bronchoscope. When Anesthesia had deemed patient ready for jet ventilation again, the ET tube was removed, jet ventilation was initiated, and the flexible bronchoscope was used to direct the needle towards the trachealis and bronchialis muscle. A total of about 20-25U was injected into each mainstem bronchus bronchialis muscle, and about 50-60U into the main trachealis muscle in multiple locations. Methylene blue was injected into the sclerotherapy catheter after the botox syringe ran out in order to determine when the botox was all used up. After this was completed, the patient was re-intubated and ventilated by Anesthesia.
Then, patient’s face was draped with wet towels, and the CO2 laser was prepared. Patient was extubated, and jet ventilation initiated again with transglottic catheter. All personnel in the OR at this time donned the appropriate eye protective wear. The laser flexible catheter was threaded through the flexible bronchoscope, which was then advanced into the trachea, and two longitudinal furrows were made over the right mainstem posterior bronchial wall extending up into the distal posterior tracheal wall. the jet ventilator was used at a laser safe mode while using the CO2 laser. The bronchoscope was withdrawn, the vocal cords were sprayed with 4% lidocaine, and the patient was re-intubated. Long grabbing forceps were used to hold the ET tube in place while the Lindholm scope was removed from the patient’s mouth, and patient was handed over to Anesthesia. The case was deemed to be finished at this point. All counts were correct at the end of the case. Patient was extubated and awakened from anesthesia without complication.
Many thanks, Jamie