- AUDIT CHALLENGE - TESTING YOUR KNOWLEDGE
1st Quarter Newsletter, 2009
Answers:
1. A - Diagnosis rendered by smoking (see NAMAS Curriculum Manual, page 60). This is a time based service, and the time must be documented. Medicare will only pay for Smoking Cessation for a systemic disease that interfers with the smoking. Medicare will not pay only for Tobacco Abuse Disorder. The documentation must also cover the counseling services that were covered - such as advising the patient to quit, why smoking is a problem, and how the patient should proceed with smoking cesation (plan of care). For our Smoking Cessation form go to www.drsmgmt.com - website search: free forms.
2. Either A or C. Actually, this is a simple, but thought provoking question. When reviewing the chart - who is seeing the patient? If it is the provider the answer is 99212. If the nurse is seeing the patient, the answer is 99211 (NAMAS curriculum manual, page 54). Did You Know This? Often, practices do not realize their nursing staff could see the patient for a follow up visit which does not require additional services. The encounter must be properly documented. If the practice is not utilizing the nurse visit, this is a great suggestion to promote efficiency for the physician.
3. D. The marvelous modifier - 22. Remember, code the operative note as documented (NAMAS curriculum manual, page 110-112). Initially, the OB/GYN begins with a lap hysteroctomy, however, the procedure has to be converted to an open procedure. Upon auditing this surgical record the appropriate reporting in the chart would be the procedure is billable by appending a modifer -22 to the final procedure to represent that additional work/extra work was performed during the encounter.
4. B. A biopsy specimen for a lip biopsy was obtained on March 1st. The specimen had to be made into a slide and was not able to be reviewed until March 3rd. The following represents proper billing of the dated services: March 1st for biopsy and pathology services. Medicare has specific guidelines regarding obtaining a specimen. These guidelines state that the specimen should be billed on the date it was obtained.
5. B. True. A Naturalist physician may bill for E&M services. Why? Only a Medicare approved class of "practitioner" performing medicine in a Natuarlists "mindset" may bill E&M services (CMS 40.4-Definition of Physician/Practitioner: rev. 4, 01-02-04). The key would be that a Naturalist could bill these services as much as they can, but will their services be recognized by the carrier for payment.
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