Recent content by JDACPC

  1. J

    Question 2 visits on one day--what modifiers should be used in physician's office?

    No modifier is appropriate in this situation. You would combine the notes and submit one code for either total MDM or total time. Here are some recent articles with better explanations: https://healthcare.trainingleader.com/2024/01/two-em-visits-same-day/...
  2. J

    Wiki 25 mod and MDM

    Pt visit + minor procedure, visit meets 25 modifier rules: Can we use the decision for that minor procedure in the MDM/risk for the office visit? A few of us have not been able to find authoritative guidance as to yay or nay. CMS says the decision is not included in the global package for the...
    • JDACPC
    • Thread
    • Replies: 1
    • Forum: E/M
  3. J

    Wiki Chief complaint

    Yes. https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/eval-mgmt-serv-guide-icn006764.pdf
  4. J

    Wiki IV Contrast and High Risk

    If you're not already familiar with the American College of Emergency Physicians (ACEP), they are a great resource! And they have great conferences, worth every penny! :D Here is a link to their FAQs which covers your question but you may want to run it by your superiors to be sure they...
  5. J

    Wiki Copy & paste MDM

    I have a new cardiology provider documenting on EVERY note "No need for SBE prophylaxis. No Cardiac medications recommended. No activity restrictions." I understand each note needs to stand alone, so maybe it would be relevant in some cases, but this is on every single visit note. SBE is pretty...
    • JDACPC
    • Thread
    • Replies: 0
    • Forum: E/M
  6. J

    Wiki critical care code 99219 question

    Yes, clinics included. Critical care is not an "in-patient only" code, can be billed at any location.
  7. J

    Wiki critical care code 99219 question

    99291 - Critical care, first 30-74 minutes, per CPT code range notes: 30 minutes or more direct care provided by physician or other qualified health care professional to critically ill or injured patient, any location
  8. J

    Wiki Pediatric Cardiac Rehab

    We're looking into starting Pediatric Cardiac Rehab services. I understand the documentation and billing, but I researched some of our major carriers polices and only one mentioned Pediatrics, stating coverage would be decided "on a case-by-case basis." Does anyone successfully get paid for...
  9. J

    Wiki 6 minute walk test

    I'm looking for the exact components that need to be recorded for the 6MWT/94618. CPT definition does not spell out each minute documentation, but CPT Assistant shows "Data on oxygen saturation, heart rate, and distance measured at 1, 2, 3, 4, 5, and 6 minutes are reviewed. Review blood pressure...
  10. J

    Wiki 6-minute walk test

    I'm looking for the exact components that need to be recorded for the 6MWT/94618. CPT definition does not spell out each minute documentation, but CPT Assistant shows "Data on oxygen saturation, heart rate, and distance measured at 1, 2, 3, 4, 5, and 6 minutes are reviewed. Review blood...
  11. J

    Wiki Split/Shared Critical Care time

    How is your organization handling time statements when the visit is a Split/shared CC visit? Are you requiring separate statements for total visit time, shared/overlapping time, and critical care minutes? Is there any official guidance on this question? I've read everything from CMS and our...
    • JDACPC
    • Thread
    • Replies: 1
    • Forum: E/M
  12. J

    Wiki Inpatient telehealth/PHE - time or MDM rule?

    For inpatient services, consult/initial visit, during the PHE, can we determine the LOS by time or MDM, or is this only for office/outpatient? Confused on what guidance is the most up to date at this point. We have a new ID consultant performing telehealth inpatient visits. Quite a difference...
    • JDACPC
    • Thread
    • Replies: 1
    • Forum: E/M
  13. J

    Wiki Lung plug device?

    Is anyone using a lung plug device and coding additional services or a 22 modifier for the radiologist's work? They are stating it's "extra work" but I'm not convinced. I have the reimbursement guide, but not helpful for professional radiology coding, and I cannot find anything on how to...
  14. J

    Wiki Fellows - attestations

    In regards to attestations, fellow and resident rules are interchangeable, correct? I am being told it's ok to bill if a fellow documents an E&M visit without an attestation but an attestation is required on surgical notes. This makes no sense to me, attestations should be required no matter...
  15. J

    Wiki How long does a doc have to complete a note?!

    Not that I'm condoning late notes but there is a difference between "unethical" and "illegal." The guidelines are somewhat vague, along the lines of "as soon as possible" but check with your MAC and office/hospital bylaws. After that, you have to deal with carrier filing limits so be sure...
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