Tag Archives | Clarification

History of Present Illness Must Be Taken by MD, NPP

Don’t let nurses do the doctor’s work, or risk downcoded E/Ms upon audit.

The only parts of the E/M visit that an RN can document independently are the Review of Systems (ROS), Past, Family, and Social History (PFSH) and Vital Signs, according to a June 4, 2010 Frequently Asked Questions (FAQ) answer from Palmetto GBA, Part B carrier for Ohio. The physician or mid-level provider must review those three areas and write a statement that the documentation is correct or add to it.

Only the physician or non-physician practitioner who conducts the E/M service can perform the History of Present Illness (HPI),  Palmetto says.

Exception: In some cases, an office or Emergency Department triage nurse can document “pertinent information” regarding the Chief Complaint or HPI, Palmetto says. But you should treat those notes as “preliminary information.” The doctor providing the E/M service must “document that he or she explored the HPI in more detail,” Palmetto explains.

Other payers have expanded on Palmetto’s announcement, letting physicians know that they cannot simply initial the nurse’s documentation. For example, Noridian Medicare publishes a policy that states, “Reviewing information obtained by ancillary staff and writing a declarative sentence does not suffice for the history of present illness (HPI). An example of unacceptable HPI documentation would be ‘I have reviewed the HPI and agree with above.’”

Good news: Thanks to this clarification, your doctor won’t have to repeat the triage nurse’s work. Right now, if the nurse writes “knee pain x 4 days,” at the top of the note, some auditors might insist that your doctor needs to write “knee pain x 4 days” in his/her own handwriting underneath. But that requirement is a thing of the past if your carrier echoes Palmetto’s requirement.

Bad news: Now this carrier has made it…

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92541 + 92544 Will Soon Be OK

AMA corrects vestibular test codes to allow partial reporting.

The Correct Coding Initiative (CCI) came down hard on practitioners who perform vestibular testing earlier this year, but a new correction, effective Oct. 1, should ease the restrictions and help the otolaryngology, neurology, and audiology practices that report these services.

The problem: CCI edits currently restrict practices from reporting 92541, 92542, 92544, and 92545 individually if three or less of the tests are performed, notes Debbie Abel, Au.D., director of reimbursement and practice compliance with the American Academy of Audiology.

The solution: Starting October 1, 2010, “if two or three of these codes are reported for the same date of service by the same provider for the same beneficiary, an NCCI-associated modifier may be utilized to bypass the NCCI edits,” CMS wrote in a decision to alter the edits.

The American Speech-Language-Hearing Association (ASHA) has requested “clarification regarding the correct NCCI-modifier to use when reporting the codes to Medicare,” noted Lemmietta G. McNeilly, PhD, CCC-SLP, CAE, chief staff officer of Speech-Language Pathology with ASHA, in a July 29 announcement.

Look for Changes to Vestibular Testing Descriptors

The root of the CCI problem began when the 2010 CPT manual was published, including new code 92540 (Basic vestibular evaluation …) and the subsequent codes following it, which make up the individual components of 92540. “The clarification that resulted in the NCCI edits being lifted should be included in upcoming versions of the manual,” Abel tells Part B Insider.

According to the AMA’s Errata page, code descriptors should read as follows, effective Oct. 1:

  • 92540 — Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and

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CMS Clarifies How to Report Audiology Services

Look for a physician order for diagnostic audiology tests.
If you thought CMS’s May transmittal on coding for audiology services was the last word on the subject, think again. On July 23, the agency rescinded the May directive and issued new guidance…

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Cardio Coders: Discover Disconnect Date’s Proper Place

Tip: You need to know the hook-up date and disconnect day.

Question: Which date(s) of service should I report for 30-day cardiac event monitoring?

Washington Subscriber

Answer: For Noridian Medicare, your Part B administrator for Washington, you’ll need to know both (1) the date the staff hooked up the patient and (2) the day they disconnected the patient. But knowing which dates to report is only half the battle — you also need to know where to report them.

When you’re reporting 30-day cardiac event monitoring, Noridian requires providers to report the hook-up date as the “from” date and the disconnect date as the “through” date in Item 19 of the CMS-1500 (or its electronic equivalent).

Watch out: You should report only the “from” date (that is, the hook-up date) in Item 24A (or its electronic equivalent), Noridian instructs. You should not report the “through” (disconnect) date in 24A because if you have dates spanning two months and only a single unit, “the system inappropriately suspends the claim and asks the provider for clarification,” Noridian states.

The codes for 30-day monitoring include 93268-93272 (Wearable patient activated electrocardiographic rhythm derived event recording with presymptom memory loop, 24-hour attended monitoring, per 30 day period of time …) and 93012-93014 (Telephonic transmission of post-symptom electrocardiogram rhythm strip[s], 24-hour attended monitoring, per 30 day period of time).

Or if the “monitoring service meets the definition of the new 30-day cardiovascular telemetry service,” look to 93228-93229 (Wearable mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage [retrievable with query] with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days …), Noridian states.

Learn more: You can read more from…

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Cardio Challenge: Discover Event Monitor Disconnect Date’s Proper Place

Find out where to report date of services on your claim form.

Question: Which date(s) of service should I report for 30-day cardiac event monitoring?

Washington Subscriber

Answer: For Noridian Medicare, your Part B administrator for Washington, you’ll need to…

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