DAVID STERN, MD (Practice Velocity) Last month, we presented definitions for medical necessity offered by the AMA and the Centers for Medicare & Medicaid Services (CMS). We looked at the elements appropriate to perform and document in the History of Present Illness (HPI). And we briefly discussed Recovery Audit Contractors (RAC) audits. (If you missed it, the column is archived on the JUCM website [https://www.jucm.com] in the May 2011 issue.) This month, our focus is …
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May 2011
Medical Necessity in E/M Coding
DAVID STERN, MD (Practice Velocity) Q.Recently some of my charts were audited and the payor challenged the levels of the evaluation and management (E/M) codes I had used. The payor said that the charts were actually coded correctly, based on the information that was documented on the chart. The auditor, however, challenged what she called the “medical necessity” of the documentation. She claimed that, based on the patients’ chief complaints, many elements of the E/M …
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April 2011
March 2011
February 2011
Coding for Intravenous Infusion, Fees for S9083, Morgan Lens Irrigation, and UB-04 Revenue Codes for Urgent Care
DAVID STERN, MD (Practice Velocity) Q.I had a patient come in who needed IV fluids and monitoring for five hours. We found the CPT codes 96360 (intravenous infusion, hydration; initial 31 minutes to 1 hour) and 96361 (each additional hour…) to use for the IV hydration therapy. However, my doctor cannot believe how low these codes are reimbursed by his health insurance. We did bill an office visit in addition to the IV. Is this …
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January 2011
December 2010
