Listserv Lately 2
by Suzan Hvizdash, CPC, CRN Senior Auditor, Instructor
On the list this week, we tackled a lot of code specific questions. It looked as though all were gratefully answered. There were some ICD-9 code questions as well as several CPT and HCPCS.
We had an Evaluation and Management question come up (my favorite). A cardiovascular Surgical Consult was the category and the History of the Present Illness needed deciphering. As first it appeared that the note was a brief history, but after pulling it apart, it was definitely extended. Here’s the note, see what you would do: “The patient is a 50 y/o female who presented through an outside hospital yesterday morning with chest pain relieved by nitro. She was found to have transient inferior ST-T changes. She was transferred here and had a cardiac cath last night which showed critical stenosis of the RCA and moderate stenosis in the LAD and left circx system of 80%. Left ventricular function was good. Pt has been pain free since the cath. Pt was on IV integrilin, 300mg Plavix, IV heparin & Nitro drip.” The breakdown can be found at the end of the column.
The big topic this week was an “incident to” scenario. It continued throughout the week with many participants offering opinions. The scenario dealt with an ARNP, CNS and an MSN. The MSN is not yet credentialed by the insurance company yet. Can the MSN’s be billed “incident to” the ARNP’s? They are not employed by the same company. The conversation continued that the MSN’s work would be done only in the hospital and even if part of the same employer, there are no “incident to” services in the hospital. The MSN (LSW) services are usually bundled into Nursing Homes services as well, and this only further complicated this scenario. Friday showed us a different side to this scenario-what if the one employee is leased? Does this change the possibilities? What do you think?
And lastly, another topic racing around was refunding Blue Cross/Blue Shield on old claims. One lister was being asked to refund a visit from 2003 because of a pricing change. Someone else had a situation where the insurance was requesting a $.02 refund or it would be off-set!!! That’s interesting!?! A more complicated scenario was one in which the insurance company was requesting a refund from several years back when it was determined that the patient had Medicare primary. The patient only had part A and is not reachable at this time. The frustration level was high as the listers were conveying their stories. The research needs to go into these situations and challenged if incorrect.
Selective and non-selective catheters were also explored. The differences are that a non-selective is place directly into the vessel under study. It’s not moved or manipulated. The selective placement can be moved into an artery other than the aorta or the vessel it started in.
As always, thanks to all who participated. We saw a few new names and some interesting questions. Hope to see more in the coming weeks. Again, if you’re not familiar with the list serve, come for visit!
Joining the list serve: $0
Asking questions on the list serve: $0
Advice given: Priceless
Here’s the answer to the HPI post that was described above.
Location: Chest
Modifying factor: Nitro
Duration: Yesterday morning
Severity: Moderate stenosis
Timing: Pain free since stenosis
Signs/Symptoms: Transient inferior ST-T changes
Until next time, I’ll see you on the list!!
*I’ll be visiting with Mickey Mouse next week. So you’ll see this column when I return the following week.