Listserv Lately 4
by Suzan Hvizdash, CPC, CRN Senior Auditor, Instructor
I’m back!! Mickey Mouse and all of his friends told me tell you Hello from the “Happiest Place on Earth.” Now, from the “Second Happiest Place on Earth” comes a summary of last week’s and this week’s activity on the CRN list-serve.
The exam component of an E/M service was a question of substance on the list. We debated what the difference between a detailed and an expanded problem-focused exam would be. It is payer specific. Some payers say that expanded visits are 2-4 body areas/organ systems, while others go with a four by four rule (4 body areas/organ systems with 4 descriptions under each one), and a third shows that at least one (1) of the 2-7 body/areas or organ systems should be more detailed. The bottom line: Ask your payer.
A few other E/M service questions popped up this week as well. HPI vs. ROS can you count elements written in the HPI area in the ROS area. In a nutshell, this example had a lot of elements in the HPI and so therefore, four (4) were counted in HPI and the rest were counted elsewhere (ROS, PFSH, etc.).
Several coding questions were answered, as usual. One was for the code on skin tag removals (11200). Another referred to the reimbursement amounts of co-surgeons. Each surgeon would be reimbursed at 62.5% of the reimbursement amount. What is the venipuncture code that replaced the G-code for Medicare? 36415.
Another big topic this week was the transporting of patients. Can an office do this? Is this a violation of a kickback ruling? Daryl made an excellent post on 8/29/05 detailing this situation. He wrote it at 9:07 pm. Just goes to show you that we never sleep!!.
One topic from last week that was discussed quite a bit (I caught the tail end of this) was the SA modifier. It appears to be a modifier used when a CRNP sees a patient under a collaborative agreement between the CRNP and the MD. It also seems that certain Medicaids are the only ones accepting this modifier. So, check with you local Medicaid before instituting.
Where to go to write a good appeal letter? A poster asked this question and was directed to Appeal Solutions where you can find help and resources for getting that appeal letter just right.
A poster relayed an experience with a seminar that turned out to be a major push for another product. How can you tell whom to trust when deciding where to spend money on seminars? You want to make certain you recognize the name and that the CEUs are from a reputable source (AAPC, AHIMA, etc.) The one place to go to for an immediate response is right here, on the list serve. With all the expert ears and eyes on the list serve, someone is bound to provide you with information about a particular seminar. Many of us speak at these seminars as well.
What about the patient getting a check in the mail for over $8000 and spending it instead of paying the physician to whom the money was due? We’ve all seen similar situations and have dealt with this in many different ways that were expressed on the list serve. You’ll want to check with management and/or your physician before trying them, but they all have worked. Some of these were: to garnish the wages of the patient or policyholder, tell the patients you’ll be contacting the IRS, get your clearinghouse involved, get the insurance company involved, or get the employer involved. So many solutions, all taking determination and time!
And finally, the most important discussion of last week, which is still on our minds this week was the horrific devastation of Hurricane Katrina. Many of our friends, colleagues, and relatives live in this area, and our thoughts and prayers are with every one of them. There are many organizations coordinating donations to be sent to this area of the country. Some are asking for clothing items, some for monetary contributions, and some for volunteer hours. The members of the list serve have such big hearts, and we know everyone will do all they can to help out. But, please keep in mind to make sure your donations and contributions are going to highly reputable organizations. Unfortunately there are entities out there trying to capitalize on others’ misfortune. Never give your credit card out over the phone when you have not initiated the call and never give cash to someone not representing a well-known organization. A few good web sites that we recommend are http://www.redcross.org , http://www.brothersbrother.org, and http://www.salvationarmyusa.org.
Until next time,
Joining the list serve: $0
Asking questions on the list serve: $0
Advice given: Priceless