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  1. L

    Wiki Chronic or old fracture

    Hoping to get some opinions on how chronic fractures or old fractures should be coded. These are noted on imaging reports without the opportunity to query. The index has note to see pathological fractures for chronic fracture, but not all bones are listed under pathological fracture, i.e...
  2. L

    Wiki "corresponds to"

    Thank you for the added validation. :)
  3. L

    Wiki "corresponds to"

    Thank you so much. I was leaning in this direction, as well, but couldn't be certain.
  4. L

    Wiki "corresponds to"

    Would the term "corresponds to" in relation to a diagnosis be considered a term of uncertainty? For example, "corresponds to a cva". Is CVA a definitive and codable condition in this context? I understand that "Consistent with" and "compatible with" are uncertain. However, "evidence of" is...
  5. L

    Wiki Consult in ED

    I found this info as I was doing further research on the topic and thought I'd share in case anyone else was had the same question as I did. This can be found in the AAPC blog at https://www.aapc.com/blog/86916-coding-ed-e-m-in-2023/. Credit to the blogger is Rae Jiminez, posted on Jan. 3...
  6. L

    Wiki Consult in ED

    Thank you for your reply and your time.
  7. L

    Wiki Consult in ED

    Good information to have, but this instance is for a consult and not a referral. The ED physician is needing the expert opinion of a neurology consult. The ED physician, in this case, is not deferring the care of the patient to the neurologist, so I'm not so sure the Noridian guidance quite...
  8. L

    Wiki Consult in ED

    Good morning, When counting data for E/M in the ED, would a request for a consult be considered "Discussion of management or test interpretation with external physician/other qualified health care professional/appropriate source (not separately reported)"? Thank you, Laura Hoot
    • lhoot
    • Thread
    • Replies: 5
    • Forum: E/M
  9. L

    Wiki LCDs and Jurisdictions

    Sls314, Thanks for the clue on how to check which jurisdictions each LCD applies to. This is helpful. Thanks again, Laura
  10. L

    Wiki LCDs and Jurisdictions

    Hello, Two quick question on how LCDs work. 1. Do the LCDs that pertain to one state in a particular MAC's jurisdiction apply to all the states in that same jurisdiction? For example, Maine and Vermont are both in Jurisdiction K with NGS. Are the LCDs the same for both states? 2. New York...
  11. L

    Wiki Abbreviation "c/f"

    Thank you so much.
  12. L

    Wiki Abbreviation "c/f"

    Good morning, Hoping to get some help on an abbreviation. Physician states "c/f heart failure". Does this mean "clinical findings of heart failure"? If that's the case, is this a definitive diagnosis of heart failure? Since he's not coming right out and saying heart failure, it's throwing me...
  13. L

    Wiki Risk Scoring for individual visits

    Good Morning, I’m hoping to get an idea of how a single visit Risk Score could be used in a practice. Does your practice calculate Total Risk Scores for each visit? How do you use the Total Risk Score in your practice? Thanks in advance, Laura Hoot RHIT, CCS
  14. L

    Wiki HCC Risk Score Calculation

    Hello, A quick question on calculating the Risk Score. Correct me if any of this is wrong, since that could be part of my confusion on the subject. My understanding is that patients with ESRD use HCC V21. The current HCC version is V24 for all other Medicare patients. Would ESRD patients...
  15. L

    Wiki Understanding HCC Process

    Thank you so much. This was very helpful.
  16. L

    Wiki Understanding HCC Process

    Thank you very much for the references. The scenario you mention, Scenario 1, is an example of the basis for my initial question. The scenario states, “The physician addressed the questionnaire with the patient, asked some more pertinent questions, and listed moderate recurrent major depression...
  17. L

    Wiki Understanding HCC Process

    Hello, Is HCC coding something done separately and in addition to regular, accurate coding of a visit or are the codes needed to capture HCC diagnoses garnered from the codes already being found for reimbursement? Some of the information I'm seeing sounds like this is a whole different process...
  18. L

    Wiki Level 2 coding with one DX?

    A single diagnosis wouldn't necessarily be the sole determining factor of the level. It doesn't look like there's enough documentation for 99309. There would need to be: A detailed interval history; A detailed examination; Medical decision making of moderate complexity.
  19. L

    Wiki Data level for sending out for consult

    Thank you so much.
  20. L

    Wiki E/M Help

    Hi KaylaRieken, Based on the info provided and the assumption this is for an office visit. I would consider the chronic stable elevated PSA to be a stable chronic illness, which is a low level of number/complexity of problems. Ordering of the repeat PSA would be a minimal level of data. With no...
  21. L

    Wiki Level 2 coding with one DX?

    Hi PPS, What type of visit is this and what else was done? Labs, imaging, further testing, Rx management, etc. Laura
  22. L

    Wiki Data level for sending out for consult

    My apologies in leaving out the type of visit my question is for. This is for an office visit. Additional work-up planned isn't part of the new guidelines, so I'm stumped.
  23. L

    Wiki Data level for sending out for consult

    Hello, If a physician sends a patient for a consult (not a referral), does this count towards data like ordering a lab or imaging would? Thanks in advance for any advice, Laura
    • lhoot
    • Thread
    • Replies: 4
    • Forum: E/M
  24. L

    Wiki Acute uncomplicated illness vs. something more

    Good morning, Need some thoughts on MDM. Would "Acute bronchitis with bronchospasm" be considered an acute uncomplicated illness, since bronchospasm is included in the code for acute bronchitis (J20.9) or would the specific mention of bronchospasm in the diagnosis be considered a moderate level...
    • lhoot
    • Thread
    • Replies: 0
    • Forum: E/M
  25. L

    Wiki Established Patient Timeframe

    Thanks so much.
  26. L

    Wiki Established Patient Timeframe

    Hello, We're having a discussion on when the time frame for an established patient expires. If a patient is seen on 10/1/2021 and the last visit prior to this was 10/1/2018, would this patient be an established patient? Would 10/1/21 be the start of year #4 or be the last day of year #3 since...
    • lhoot
    • Thread
    • Replies: 3
    • Forum: E/M
  27. L

    Wiki Incident-to

    Thomas, Thank you so much. Your explanation is how I was understanding the incident to, but just couldn't find it plainly spelled out like that. Thank you again, Laura
  28. L

    Wiki Incident-to

    Good Morning, I’ve posted a previous question on this same topic, but hoping a different take on it might produce some replies. I have a couple questions concerning incident-to billing in an Urgent Care setting. First, is it appropriate to code for incident-to billing in an Urgent Care setting...
  29. L

    Wiki Procedures done by non-physician providers

    Good Afternoon, Is there a resource or list of cpt codes or procedures that a nurse or other non-physician provider are allowed to do and still bill by the physician? One example I know of is removal of impacted cerumen using irrigation (69209). Are there others? Thank you, Laura Hoot, RHIT, CCS
  30. L

    Wiki New vs Established e/m codes

    msksmith, Please accept my apologies for not responding in a timely fashion. I've learned that I don't have my alerts set up quite right and didn't realize you replied. In response to your question, I'm not well versed on the the nursing specialties, but I did some looking into it. If my...
  31. L

    Wiki New pt, simple office visit

    Good Afternoon, Need a couple extra braincells on this rainy afternoon. New pt in office for hematuria. Culture ordered, being referred to urologist for further workup. No other significant dxs or chronic conditions, no other testing, imaging or diagnostic tests, no meds or other treatment...
    • lhoot
    • Thread
    • Replies: 0
    • Forum: E/M
  32. L

    Wiki Undiagnosed new problem with uncertain prognosis

    Thanks so much, Thomas. Sometimes, hearing an explanation in a different way sheds more light on the subject. So, in determining an undiagnosed new problem, it’s not the actual problem necessarily, but the physician’s response to the problem. Thank you again, Laura
  33. L

    Wiki New vs Established e/m codes

    If the physician seeing the patient for the STD is in the same multispecialty practice as the GYN and is: not a GYN, and not considered a different subspecialty of GYN, and has not been seen by any other physician in the same specialty or subspecialty of the STD physician in that practice in the...
  34. L

    Wiki Undiagnosed new problem with uncertain prognosis

    Good Morning, My question has to do with complexity of problem in determining E/M. Does a final impression/final diagnosis of a symptom constitute an undiagnosed new problem with uncertain prognosis? Example would be patient seen for abdominal pain. Assume both cases are identical except for...
    • lhoot
    • Thread
    • Replies: 2
    • Forum: E/M
  35. L

    Wiki Z99.2 when patient not on dialysis...yet

    Thank you so much. Laura
  36. L

    Wiki Z99.2 when patient not on dialysis...yet

    Good Morning, I have an odd scenario. Patient with CKD stage 4, status post right upper extremity AV fistula. Patient is not currently on dialysis, but physician anticipates this will be needed in the near future. Should Z99.2 be coded? "Presence of arteriovenous shunt for dialysis" is...
  37. L

    Wiki Diagnosis for inpatient visit

    Thanks so much for the sanity check. :)
  38. L

    Wiki Diagnosis for inpatient visit

    Good Morning, I have what might be a somewhat simple question, but I’m stuck in an inpatient thought process and just want to make sure I’m on the right path. Does the physician billing for his visits during an inpatient stay use diagnosis codes pertaining to the patient’s conditions at the...
  39. L

    Wiki IVP minutes before Infusion of same drug

    Thomas, You are correct. Definitely meant 30 minutes. I think I had the "more than 15 minutes" time frame stuck in my head for the requirement to be an infusion. Thank you for answering my intended question. IVPs of the same substance as an infusion done within 30 minutes of each other...
  40. L

    Wiki IVP minutes before Infusion of same drug

    Good Afternoon, Need some thoughts on an infusion and injection scenario. Per the times documented, an IVP was given just prior to an infusion of the same drug. ondansetron 2 mg/mL Inj 2mL Infusion Start^ 13:43 Infusion End^ 16:15 ondansetron 2 mg/mL Inj 2mL Admin Start^ 13:42 Admin Does the...
  41. L

    Wiki Hydration diagnosis requirement

    Would that mean, barring any facility policy/guidelines, hydration is reported whenever fluids are given?
  42. L

    Wiki Hydration diagnosis requirement

    Good Afternoon, Need some clarification on hydration administration coding. Can hydration be coded when there is no documentation stating the fluid administration is for hydration or if there is no diagnosis that would make hydration medically necessary? Is hydration coded strictly based on...
  43. L

    Wiki Infusion Coding

    Good Afternoon, I'm hoping to get some guidance on infusion coding. The scenario is patient in ED for gastroenteritis and dehydration. Infusions and injections include: piperacillin-tazobactam/NS - Infusion Start^11/01/2020 00:10 Infusion End^11/01/2020 00:45 Sodium Chloride 0.9% - Infusion...
  44. L

    Wiki E/M for Med refill scenarios

    Good Morning, Need some help untangling the logic for visits for medication refills in different visit settings. Pt is seen for asthma med refill. No exacerbation or issues are noted. Comprehensive History and Comprehensive Exam is done. According to the established matrices for code...
    • lhoot
    • Thread
    • Replies: 0
    • Forum: E/M
  45. L

    Wiki More than one acute uncomplicated illness

    Good Morning, Would the number of dxs have any bearing on the Number and Complexity of Problems Addressed for the new guidelines for outpatient visits? Low indicates one acute, uncomplicated illness or injury; however, there is no further direction if there is more than one acute, uncomplicated...
    • lhoot
    • Thread
    • Replies: 2
    • Forum: E/M
  46. L

    Wiki Aftercare s/p 1 yr from surgery

    That makes perfect sense. Thank you so much for the clarification on the necessity for continued monitoring. Laura
  47. L

    Wiki Aftercare s/p 1 yr from surgery

    Thank you so much for your help and further explanation. Physician coding is a new realm for me, so I'm overthinking a bit. Thank you again.
  48. L

    Wiki Aftercare s/p 1 yr from surgery

    Sorry, the statement I made about the low back pain is a little confusing. Yes, the sacroiliac pain is unrelated, not due to, the hip replacement. Dr. thinks patient is having some other lumbar issues that might be causing this. The reason for visit is stated as "presents repeat evaluation 1...
  49. L

    Wiki Aftercare s/p 1 yr from surgery

    Requesting some help on an aftercare scenario. Pt is being seen 1 year status post hip replacement. X-rays are done. All is well with the hip replacement and pt is to return for re-check as needed. Pt also mentioned some low back and buttock pain, unrelated to the hip replacement nothing...
  50. L

    Wiki Inpatient E/M

    Thank you so much for the insight. Your explanations are definitely making it clearer. The notes I'm looking at are inpatient acute care progress notes and I'm looking at just individual notes. Plans for some of the conditions are documented well enough that I can tell the physician is...
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