Listserv Lately 6
by Suzan Hvizdash, CPC, CRN Senior Auditor, Instructor
This week we tackled some interesting subjects; everything from CCI edits, to allergy billing, to patient dumping. Never ceases to amaze me as to the caliber of experts we have in our community. Everyone wants to do it right. And everyone also wants others to do it right! That’s a real community I’m very happy to a part of!!
The question concerning the dumping of patients involved a pediatric orthopedic practice who was seeing more and more Medicaid Managed Care patients which the other practices in the area didn’t participate. Is it required to follow a patient that you see in the ED even if you don’t participate with the patient’s insurance? The consensus was that the private offices didn’t have to follow these patients. If they didn’t participate with the insurance, they were not required to see them after the ED visit. It seems a bit off balance in this particular area that one practice is seeing the majority of these patients and not getting the others. One poster suggested arranging a meeting of all of the practices to discuss this. Keep us posted!
Discharging from observation: Which code set is best? The question was why was the 99238 denying? When a patient is in observation, the discharge code would be the 99217. If the patient was in and out on one calendar day (not the case of this patient) then the 99234-99236 codes would be the appropriate ones to use.
Then there’s the CCI questions! Chocolate cream pie!! I’ll never look at those frighten charts again in the same way!! But, what a helpful way to look at those columns. The question referred to the relationship Column 1 has with Column 2. If 97112 is in column 1 and 97140 is in column 2, why wouldn’t 97112 be in column 2 when 97140 is in column 1? All these columns-and I’m not even in Greece! The chocolate cream pie explanation was that column one is the pie and column 2 is a piece. The latter is part of the first, but it cannot be reversed. If they were mutually exclusive codes they would then be in each other’s column 2s. Now where’s that pie!!??
Hope you all got what you were looking for this week on the list.
As we begin another busy week, let us all take time for thoughts, prayers, and hopes for the folks in Hurricane Rita’s path.
Until next time,
Joining the list serve: $0
Asking questions on the list serve: $0
Advice given: Priceless