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Shared Visits in the Hospital for Medicare
I have a question regarding 2023 shared visit rules. I am reviewing an E&M note where I will select the level of E&M based on the MDM being the substantive part and not time. My question: does each provider have to document their individual time if not a factor in the level of E&M I recommend?
Time
Our physician is coding by time; he thinks this is the best for him. Frequently with a new patient he will also do an injection. He documents his total time for the day but does not document the amount of time performing a minor procedure (billable). There is no documentation of the time spent preparing for or performing the minor procedure. May we still report a service based on time?
Diagnosis Coding Excludes 1 Codes
Our physicians list their diagnosis codes in the Assessment section of their notes. They link the diagnosis codes to the charges in our EHR. We receive a claims submission edit stating the two diagnosis codes may not be reported together. We review the rules and find the codes have an “Excludes 1” relationship. Our question is, should we remove the diagnosis code that is listed as the “Excludes 1” from the Assessment section of the note when correcting the claim based on the guidelines.
Established Patient Encounter: Is Modifier 25 Supported?
An established patient presents to the office for return of knee pain six months after the last injection to the same knee. The patient relates no new injury and states that over the past few weeks, the pain has become unbearable. The physician evaluates the patient and decides to reinject the same knee. Does this meet the modifier 25 definition since the physician re-evaluates the patient?
Date of Service
We are in an academic setting. Our residents will see a patient, for example, at 11 pm on Tuesday. Wednesday morning, our attending physician evaluates the patient, documents his/her findings, documents the required attestation, and enters an E&M into the EHR. The date of service is the date the encounter was created by the resident on Tuesday. Do you bill the E&M with the Tuesday date of service or the Wednesday date when the attending physician saw the patient?
Coding Percutaneous Rods and Screws: Part 3
If percutaneous rods and screws are placed without a parent or primary code, for example as a staged procedure a different day after an ALIF or as the sole treatment for a vertebral fracture. I understand an unlisted code (22899,Unlisted procedure, spine) must be reported. What should be used as a comparative code to set the fee. The instrumentation codes, +22840, etc?
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