Listserv Lately 20
by Suzan Hvizdash, CPC, CRN Senior Auditor, Instructor
I cannot believe we are into May already. I’m still catching myself writing 2005 on my checks!
But here we are and the weather has just been wonderful (here in PA). The list was quite lively these past few weeks. We really did have a lot of questions flying around. I saw that most were answers - that’s why I love it here!!
Let’s see, we had a lot of diagnosis questions. What’s the ICD-9 code for tendon tightness, MEN 1, anxiety, dislocation of a finger? Well, those answers were given quickly and with good explanations to back the answer up. We may not always get it right, but we justify the reasons for our answers. This is such healthy dialogue! 727.81 was the code recommended for tendon tightness, 834.00 for finger dislocation, 300.00 for the specific problem of Anxiety, and let’s not forget my question about MEN 1-239.7. The scenarios for some of these codes didn’t start out as simple as tendon tightness, but through the expert minds of the CRN listers, these codes were the ones pulled our of that large diagnosis book we all know affectionately!!
On the same line with the diagnosis coding, we should also acknowledge, as a thread pointed out that the code selected should be the correct code for the problem, not necessarily the one that’s going to get the claim paid. Compliant diagnosis coding is an extremely important area of concentration. We need to make certain that we are not arbitrarily assigning codes “just to get the claim paid.” We need to provide a complete and accurate picture to the payers and not give a patient a disease he/she doesn’t have.
What about CPT codes - we’ve got questions on those as well. Scar revision, 14040, was just one example of the types of questions we got on CPT coding.
What’s a recovery audit company? Discussions took place on exactly what these companies were and how they operated. From what was discussed, these are companies hired by the payers to make certain that the payment for a claim was correctly reimbursed. They get the medical records from the provider and read it for medically necessity, etc. comparing it to the claim that was submitted and ultimately paid. The Medicare carriers are going through these audits now (CERT: Corrective Error Rate Testing). To see the whole thread you could start at http://health.groups.yahoo.com/group/CRN-L/message/52944.
Other areas that we tackled were questions about blood draws, phone calls, seminars, and pain management.
Congratulations to all of the listers who took the CPC-P and passed. Among them are Annette Grady, Chelisa Clark, and of course Barbara Cobuzzi !!! Great job!! And speaking of payers, we had a great discussion on the list about how the CRN list serve is very open minded to all: to providers, auditors, consultants, payers, etc. We should all try to be one big happy family - and I think we accomplish that here!
Lastly, I think there was a “brief” discussion about consultations. I’m not sure, I thought I may have caught an e-mail or two…or TWENTY on this subject. Between the information we’ve been receiving through the OIG, CMS, the PRIT memo, Dr. Whitten (Noridian Medicare Carrier), Quin, Collette, Barbara, Connie, Chris, and a host of others have been scrambling to clarify the new information regarding consultations. Can the requester transfer care without the consultant's input? Can the consultant bill for a consultation without the request in writing? Should the patient be a new patient or a consult if the physician treats the problem? These are questions that really can’t be answered clearly at this time. But, if you’d like to join in on the conversation you can start by looking at the thread http://health.groups.yahoo.com/group/CRN-L/message/53161. This has been a very informative and lively discussion. I, personally, love when we really get into a topic like this.
A busy AND informative group!!!
Joining the list serve: $0
Asking questions on the list serve: $0
Reading your bi-weekly CRN newsletter: $0
Advice received on the list serve: Priceless
The value of reading your bi-weekly CRN newsletter: Priceless
Until next time,
-- Suzan