1. A 45-year-old female patient with a diagnosis of primary osteoarthritis returns to the office for her second scheduled injection of sodium hyaluronate (Supartz). The nurse takes the patient’s vitals: weight is 185 lbs., height is 5’2”, and temperature is 98.2°F. The patient is prepped and given the injection. How should this encounter be coded?…
ICD-10 Code Change Proposed
On Sept. 12, the ACR and the Sjögren’s Syndrome Foundation presented an ICD-10 code change request for Sjögren’s syndrome to the ICD-10 Coordination and Maintenance Committee (C&M) at the CMS office in Baltimore. The request is intended to clarify ICD-10 M35.0: sicca syndrome [Sjögren]. Why Change the Code? The rationale behind this significant change request…
Coding Corner Answer: Coding Scenario for 1997 Musculoskeletal Exam
Take the challenge. CPT codes: 99203/99243 ICD-10: M25.521, M25.522, M25.561, M25.562 History—Comprehensive: The history of present illness is extended, the review of systems is complete, and the past medical, family and social history are documented. All three of the HPI, ROS and PFSH are needed to achieve the history level as comprehensive. Examination—Detailed: This level…
Coding Corner Question: Coding Scenario for 1997 Musculoskeletal Exam
A 55-year-old female patient with pain in multiple joints is referred to the office by her primary care physician. She complains of pain in both knees and both shoulders. She rates the pain at 7 on the pain scale. Her pain is worse at night after she gets off work. Soaking in her hot tub…
Coding Corner Answer: To Bill or Not to Bill an Eval & Management Visit?
Take the challenge. Scenario 1 is the correct answer. Although documentation of both scenarios supports a Level 4 visit, only one supports the medical necessity to code an evaluation and management (E/M) visit on the same day with a procedure. Scenario 1 supports the need for a separate E/M visit, because a new problem was…
Coding Corner Question: To Bill or Not to Bill an Eval & Management Visit?
Scenario 1 History: A 45-year-old male patient with sero-negative rheumatoid arthritis affecting multiple sites, but with no organ or systems involvement, comes for a follow-up visit. The patient reports swelling of the left knee with throbbing left knee pain. He rates the severity of his pain at an 8 on a 10-point scale. The pain…
2019 Proposed Rule for MIPS Performance Year 3
The CMS has submitted its annual proposed rule, which continues the transition to a value-based model, for comment by stakeholders and the public for the 2019 MIPS performance year (Jan. 1–Dec. 31, 2019).
UHC Announces New Policy on National Drug Code Requirement
Effective Sept. 1, 2018, United Healthcare’s (UHC) new policy for National Drug Code (NDC) reimbursement will require providers to include additional drug-related codes submitted on the CMS-UB04 and the Electronic Data Interface (EDI) transaction 837i. All outpatient claims submitted to UHC commercial and UHC Medicare Advantage plans with a date of service on or after…
How to Document the Physical Exam
The adage frequently cited in healthcare settings, “If it isn’t documented, it wasn’t done,” still rings true for the key components required in a patient’s medical record. The note in the medical record must sufficiently describe all of the services furnished to patients on a specific date. The essential requirements to appropriately bill a claim…
Coding Corner Answer: Evaluation & Management Documentation Quiz
Take the challenge. B—The presenting problem(s) is what is evaluated during the history and examination by the provider. The chief complaint is in the patient’s own words or is a follow-up for his or her current condition. The history of present illness, along with the review of systems, usually guides the provider through the examination….
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