Pulmonology Coding Alert
You Can Refer to MD-Owned Sleep Lab
Question: North Carolina Subscriber Before pursuing the DME option, you should consult with an attorney. Although sleep studies (polysomnography 95808-95811) are not a designated health service (DHS), CPAP equipment is. So although you can refer patients to a lab that you have a financial interest in for the study and be OK, Stark kicks in for the CPAP dispensing under DME. Stark II law prevents the sleep lab owner (or referral source) from also owning a medical equipment company, unless it represents "an extension of practice" for the sleep provider. An attorney well-versed in healthcare law and Stark could make this distinction. Even so, managed-care companies often designate specific providers for services, similar to capitated lab services.
Answer: When you manage the patient's follow-up care, you should use 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient É) to capture the professional services.
Pulmonology Coding Alert
- Look for This $125+ Boosting Phrase in Diagnostic Scope Notes
Error averted: Drop 31575 when biopsy occurs Reporting 31575 when your pulmonologist actually performed 31525 [...] - You Be the Coder:
How to Weigh Vent Management Vs. E/M
Question: A pulmonologist visits a patient with acute respiratory failure in the medical intensive care [...] - 6 Tips Keep Your Inpatient E/M Coding On The Up-And-Up
Medicare overspends millions on upcoded inpatient visits Carriers are scrutinizing your inpatient hospital visits more [...] - OIG Is Watching Your Doctor's Nursing Home Visits
Part B payments 'vulnerable to fraud,' watchdog says Nursing homes could be hotbeds of inappropriate [...] - Reader Question:
You Can Refer to MD-Owned Sleep Lab
Question: We are a pulmonology clinic plus a sleep lab with two beds, and we [...] - Reader Question:
Stick With Nonspecific Code for MIPs & MEPs
Question: What is the correct way to bill for maximum inspiratory pressures (MIPs) and maximum [...] - Reader Question:
Must You Always Follow NCCI Edits?
Question: When specialty society guidelines differ from National Correct Coding Initiative edits, a commercial payer [...] - Reader Question:
Report Bilateral 32002 on One Line
Question: I submitted documentation with a line-itemized claim for three same-day services/procedures as follows:
--99233-25 (Hospital [...] - Reader Question:
Look Beyond HPI for Chronic Condition:
Question: The 1997 audit guidelines state that I can reach an extended history by updating [...] - Reader Questions:
Use This Diagnosis for Asthma With Croup
Question: An established patient with a history of asthma who is now taking Albuterol presents [...] - Prove Patient Is 'Critical' When You Report 99291
CPT considers many services part of the critical care package When deciding whether your pulmonologist [...]
