I also posted this in coding but i’m curious how billing handles this we have some colleagues who have different opinions on this. If most of your patients are seen for complications or are at higher risk and most of their visits are billed to insurance with an E/M (some cover these and don’t require you to bill out at time of delivery) how are you handling global? Since some of these patients have zero routine visits at the time they deliver because their complications or high risk visits were billed and paid are you splitting the global since there are no routine visits? ex 59410, 59515 etc… or are you counting the high risk visits as prenatal even though they were paid to equal the 10-13 visits allowed by most carriers.
Click here for more sample CPC practice exam questions with Full Rationale Answers
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
Tag Archives: RISK
High Level of Risk : MDM
Would you agree that the diagnosis below reach a High level of risk for MDM?
Impression and Plan Summary:
Abnormal finding on a mammogram.
Orders: Mammo: screening bilateral mammogram.
DIABETES MELLITUS – TYPE II- WITH RENAL COMPLICATIONS. reviewed labs and made a copy for patient
CKD STAGE 3 (GFR 30-59) advised to drink more water, recheck labs in a month
orders: basic metabolic panel, microalbumin.
Additionally, iron deficieny, overweight (bmi 25-29.9), diabetes mellitus-type II- with neurological complications, hypertension with ckd, depression, gerd, and hyperlipidemia mixed have all been reviewed and are stable.
– Due to the renal complications and CKD would you say that it is appropriate to consider this a high level of risk under the presenting problems column.
TIA
KM
Medicare Risk Subsequent visits POS 22
We are a cardiology practice and are having stuggles with one of our Medicare Risk plans denying 99225 or 99226 visits. We have been instructed by our billing company that this plan has it’s own "rules" and they will only accept one subsequent visit code per day regardless of provider or diagnosis. We have been instructed to change our denied codes to office visit codes 99213 or 99214. I believe this advice to be incorrect. If Medicare Risk plans follow CMS guidelines then it would be inappropriate to change these codes in my opinion. I am curious if any other specialist office is struggling with billing for their services/visits on hospital outpatient/OBS codes? And, am I incorrect in thinking we should continue to bill these codes and appeal these denials? Any thoughts or experiences/suggestions on this topic will be very appreciated!
Risk Table
When you are deciding on the Level of Risk (Box C) How do you determine which column is the best to use? Do you always choose the one that will get you the highest e/m level? If the patient has 3 stable problems and 2 of them are chronic, that would automatically get you to a moderate decision making level. Any advice would be greatly appreciated.
E/M Risk Help Please :-)
Office visit for established patient – 2 acute sprains due to MVA, one of neck and one back. Doc orders massage therapy, ice and script for naproxen 500mg and methocarbamol 500 MG.
Is this low risk because of the level of acuity of sprain and the massage therapy/ice…or does the level bump up because of script for naproxen and methocarbamol?
Thank you in advance!
Audit Risk When 1 Dx Code is Listed on Claim When Multiple Exist in Notes?
My employer is having software issues and a (hopefully temporary) fix has been proposed to include only 1 Dx code per claim. Are we increasing the risk of getting audited? We are a community mental health facility and serve a high Medicare/Medicaid population.
Thank you for any assistance provided!
Annette Vesey, CPC-A
New Risk Assessment Codes
Hi. My pain management practice is using 2 forms of risk assessment questioning for our pain management patients. One is computer-based – w/ staff assistance. The other is done on paper and interpreted by the provider. We were using 96103 for the computerized risk assessment. 2019 codes are completely different. Can we code both 96146 for the automated testing and scoring and 96160 for the paper risk assessment that is scored by the provider? Or is there another code more suitable? Any guidance is appreciated.
Identified Risk Factors in High Medical Decision Making for a Potential Malignancy
There is a debate between the doctors and our department:
An ultrasound was done and the patient has a 5 cm mass near her ovary. The MD is planning surgery to remove the mass, it is not known for certain whether or not the mass is benign or malignant. The MD believes that the mass is an identified risk factor because the mass is potentially cancerous. We believe that at this point, the surgery should not be given credit for high risk surgery with identified risk factors because the mass is not identified as being cancerous at this point.
I could consider this being a risk factor if the provider makes the case for it in the note, but just a mass with the potential of being malignant we do not believe to be an inherent identified risk factor.
Thoughts???? Thank you!
Providers at Risk for Noncompliance of Medicare Beneficiary Identifier
As of January 25, only 62 percent of healthcare providers submitted fee-for-service claims with the new Medicare Beneficiary Identifier (MBI), according to the Centers for Medicare & Medicaid Services (CMS)(MLN Connects, Feb. 7). Is your provider among the 28 percent who haven’t begun to use the MBI for Medicare transactions? Providers have until Dec. 31 […]
The post Providers at Risk for Noncompliance of Medicare Beneficiary Identifier appeared first on AAPC Knowledge Center.
MDM risk table question
On the MDM risk table on the far right column where it talks about minor/major surgery w/identified risk factors…..does the provider actually have to SCHEDULE them for the surgery and it be the definite plan of care for the patient OR can he just talk about the ‘options’ of the surgery and go over benefits and risk factors but let the patient think about it and not schedule it that day? Does he get credit in that section for going over all of it in the absence of actually scheduling/planning it?