1. B

    Wiki Outpatient provider providing services to patient in the hospital

    Hi all, I have not come across this before so was hoping to get some guidance. I work for a behavioral health group practice in an outpatient setting (mainly office and telehealth). One of our LCSW's patients was admitted to the hospital due to an unrelated condition, and requested a session...
  2. B

    Wiki Is there a non-3M way to group APR-DRGs?

    I need to assign APR-DRGs so that I can calculate state Medicaid reimbursement for some hypothetical patient cases, but I don't have access to the 3M encoder (which costs tens of thousands of dollars). Is there another way to accomplish this?
  3. A

    Wiki Inpatient- Capturing Secondary Dx Appropriately

    Hello I am looking for feedback specifically for Inpatient visits. Currently, I follow the below advice for IP auditing. For OP, I use M.E.A.T to help guide coders and other auditors on my team for capturing SDX. Our facility does not specifically apply M.E.A.T to our IP area at this time...
  4. A

    Wiki Inpatient- Capturing Secondary DX Appropriately

    Hello I am looking for feedback specifically for Inpatient visits. Currently, I follow the below advice for IP auditing. For OP, I use M.E.A.T to help guide coders and other auditors on my team for capturing SDX. Our facility does not specifically apply M.E.A.T to our IP area at this time...
  5. C

    Wiki Surgery after Inpatient Fall

    I am very new to Inpatient coding and need some help please! We had a patient come to our hospital for a Right Total Knee Arthroplasty. Two days later, during his inpatient stay, he had a fall in the hospital and landed on his knee, splitting open his surgical knee wound. He was brought to the...
  6. P

    Wiki Diagnosis not documented on DOS

    We are doing profee billing for hospital care services. For the initial hospital care (99221-99223) visit documentation states that patient came into the hospital and was found to have an Acute Kidney Injury secondary to Rhabdomyolysis. Coders reported N17.9 (AKI) for this encounter, not...
  7. B

    Wiki Inpatient Time Based Billing

    What documentation is needed? The subject is inpatient billing by time documentation requirements. At work we are recently told that more than 50% counseling does not have to be documented, that it is inferred in the inpatient setting, that the provider only needs to note his total floor/unit...
  8. J

    Wiki Extended ER

    I have a scenario that I have never come across before so I want to get some input. Patient presents to ER on 1/6 for chest pain. Cardiac protocol followed. Patient was planned to be transferred out for higher level of care but no beds were available at any of the hospitals in the state. The...
  9. V

    Wiki Medical Decision Making Table (Number of DXs or Treatment options, DATA Reviewed, and Risk table) Examples for Inpatient Hospital Coding 99221-99239?

    Hi, I wanted to ask if someone can provide me with some links or websites or anything really, that may have a list of common illnesses/injuries that are good examples to use for the different levels of the MDM table for Inpatient Hospital Coding (99221-99239) For example, just like on the Risk...
  10. P

    Wiki After CDI queries...

    Question: I'm an inpatient coder at a large hospital. I am new, so not quite sure how to deal with this situation. After CDI has done their initial review on a chart, did some early queries and received answers back, BUT as the patient's hospital stay continued on, other doctors specified the...
  11. P

    Wiki Inpatient Coding questions

    Hi there, I am a relatively new inpatient coder at a large hospital. Sometimes I just want a message forum to ask coding questions (about specific codes, or about the coding process or hypotheticals). What message forum should I ask these questions? Right here in General Discussion? Inpatient...
  12. S

    Wiki Outpatient or Inpatient E/M

    I have a provider who saw a new patient via telemedicine. This patient was an 'inpatient' at an outside facility for unrelated symptoms. My provider isnt privileged at the patient's hospital. What would be the correct E/M code or location? Thank you.
  13. K

    Wiki Hospital Billing Confusion..please help?

    My doctors at my clinic take turns doing rounds at our local hospital. These are the scenarios that I am confused about if anyone can help answer I really need to pick someone's brain. 1) pt arrives in ER and our doctor ends up seeing them that day and decides to admit(date 6/18). the hospital...
  14. A

    Wiki Post-op chemo and subsequent visits

    Any thoughts on this would be much appreciated. We have received several denials for subsequent hospital visits as "“Pre/post-operative care payment is included in the allowance for the surgery/procedure.” Patient had a biopsy of a mediastinal mass performed using the chamberlain procedure...
  15. C

    Wiki Inpatient 99441

    I work for a group of Hospitalist that includes a group of Infectious Disease physicians. We see patients at several different locations with in the same health system. The Infectious disease doctors are calling the the nurse and treating the patients by phone call only at one of our out...
  16. A

    Wiki OMT and place of service

    Are there any restrictions on where OMT can be performed? Can this be done at an acute care inpatient setting and/or ER?
  17. R

    Wiki Help! Rule(d) Out Diagnosis Guidance for Inpatient

    Hi, when a diagnosis for inpatient at time of discharge states rule out or ruled out, should the diagnosis still be coded? In the inpatient guidelines it states "still to be ruled out" diagnosis can be coded? I just need clarification.
  18. J

    Wiki Inpatient Hospital Billing for Telehealth - HELP

    Can anyone please inform me if any of their MD's are seeing patient's remotely from home and using telehealth/telemedicine charges. If so what are you using to bill to the insurances G0406-G0408? or should they bill NP consult via telemed/health as 99446-99449 Thank You for support guys!!!
  19. J

    Wiki Medicare COB Question for IP Stay

    When a member becomes eligible for Medicare Part A in the middle of their Inpatient stay, how is the biller to submit a claim? The patient had Medicaid State SSI as coverage upon admission which fell to secondary payor once the patient was entitled to Medicare Part A. Is SSI responsible for the...
  20. J

    Wiki Inpatient Claims Split

    The patient was admitted on 09/27/2019 for pneumonia. The patient was discharged on 09/30/2019. The patient was admitted to the hospital again for shortness of breath less than 24 hours later on 10/01/2019, then discharged on 10/05/2019. The DRG for both stays is the same. Should this have been...
  21. J

    Wiki Inpatient 90846

    I have an inpatient psychologist that wants to provide family psychotherapy w/o patient 90846 (patient is an infant in the NICU) to the mother. What dx should they use? Do they dx the mother? The provider wants to use the infants medical condition as the reason for the 90846, but i dont think it...
  22. C

    Wiki What is the best software to determine DRG assignment?

    Hi, I am a coder with HCC experience who is now trying to break in to inpatient coding. I am very new to DRG assignment and am currently trying to figure out what the best software program is to help with figuring that out. (Sorry if this sounds ignorant). Any advice or recommendations would...
  23. S

    Wiki Childbirth aftercare codes

    When coding a inpatient hospital subsequent day after mother has the baby, what code would you use? Z391, Z392 or both? please explain. I have several different opinions in my department.
  24. J

    Wiki Inpatient 90846 & 90847

    Hello, I'm a professional fee coder for a behavioral health group. Around 09/01/18, insurances have been denying inpatient 90846 & 90847 as 'invalid place of service.' Has anyone else ran into this or does anyone have further information? Any thoughts or advice would be appreciated. Thanks...
  25. H

    Wiki subsequent orthopedic inpatient visits, i. 99231, 99232

    I am an orthopedic coder needing some clarification. A patient is initially seen in the ED with a femoral neck fracture and the ED provider is requesting Ortho consultation; a hospitalist accepts them as an admit. The Ortho provider consults and determines that the patient needs to be taken to...
  26. J

    Wiki oh heaven help me.

    Hello! My name is Jordan and I am recently employed in a Colorectal Surgeon practice that also houses a GI doctor for IBD and they all do Inpatient rounds as well as procedures and surgeries. This office has lacked a coder, biller, A/R person for at least a year and is in just a mess. I have a...
  27. J

    Wiki INPATIENT --- Over My Head

    Hello! My name is Jordan and I am recently employed in a Colorectal Surgeon practice that also houses a GI doctor for IBD and they all do Inpatient rounds as well as procedures and surgeries. This office has lacked a coder, biller, A/R person for at least a year and is in just a mess. I have a...
  28. B

    Wiki Hospice Inpatient - Provider Not employeed with Hospice

    My provider is a family practice doctor who recently had a Hospice patient as Inpatient. The patient was seen for Hospice related diagnosis and has Medicare as primary and Medicaid secondary.... Can I bill medicaid? I am aware of modifiers GV and GW... We are based in Louisiana. I am having...
  29. A

    Wiki Sepsis resolved inpatient profee

    If sepsis is documented as resolved in the A/P on a patient who is still in the hosptial and the patient is no longer on antibiotics for it would you still code it if it was the reason for admission?
  30. B

    Wiki Ortho to Hosp Admit

    B][/B]I need some help with an e/m situation. I have a doctor here in our Ortho practice that saw a patient on one day (lets say Monday) and admitted her that day to the hospital. He is also the operating surgeon and saw the patient the next day (lets say Tuesday) in the hospital and then...
  31. baroquecoder

    Wiki Denials for 93042 with 99223

    I am seeing a lot of denials from the earlier part of the year for a 93042 when ordered in the inpatient setting. Has anyone else experienced this? Biller is telling me to put a modifier 59 on it. Any advice would be appreciated. Should mod 25 go on it?
  32. D

    Wiki 2 inpatient visits on same day

    Can 2 providers in the same specialty, same practice, bill for inpatient visits on the same date of service? If so, is there a modifier required on one or both visits?
  33. P

    Wiki Billing initial inpatient admissions from same specialty

    Can you bill an initial inpatient admission code when an attending provider from the same specialty of the admitting provider sees the patient? (Does this vary per insurance carrier?) Example: Dr. John from urology admits the patient (via order) at 1pm after the resident sees the patient. Dr...
  34. P

    Wiki Inpatient Admission and initial contact by admitting physician

    Our coding compliance manager has some of my coworkers and I perplexed. She is stating that if an admission occurs before midnight, let's say at 11:30pm, and the admitting physician sees the patient after midnight, let's say 12:05am, then we cannot bill an initial inpatient admission code...
  35. B

    Wiki Revenue Code 200 ICU

    Hello thank you in advance to any response I receive to this question. I am CPC who deals primarily in Professional coding and billing for my daily work. I'm trying to learn a little more about facility coding to aid a friend who had spent some time in the hospital recently. This individual was...
  36. M

    Wiki Inpatient planned procedure

    Question: A patient is consulted with ENT on 6/20/16 due to hx of SMA type 1 and evaluation for tracheostomy. They state that they will plan for tracheostomy on 6/22/16. I can bill for the consult on 6/20/16, but could I also bill for the subsequent visit on 6/22/16 with a 25 modifier? Please...
  37. D

    Wiki Inp Neurology Single System Exam/Gait Credit

    On Inpatient Neuro Exam: Dr. states "Station/Gait: unable to stand up due to severe dizziness." Does he qualify for full credit. **Gen app, Vitals, Fundus, CV, MS, CN, Tone, Strength, Reflexes, Coordination, Sensation are all examined.
  38. D

    Wiki Correct ROS documentation

    I do coding for inpt consult and initial hosp visits. My attendings are under the impression that they should get credit for a comatose or intubated pt if the ROS are not done. How should ROS be documented in this case?
  39. Z

    Wiki Coding Falls Without Injury

    A hospital inpatient falls, but does not incur any injury or other problems as a result of this fall. What primary diagnosis code would you use? Would you use ICD-10 diagnosis code R29.6? Thank you for your suggestions!
  40. D

    Wiki Inpt consultation codes (Neurology)

    When coding using pr
  41. G

    Wiki Newly Certified CPC-A Seeking Opportunities in the Sacramento?Roseville Area

    Also I am available for remote and in office opportunities at an Entry level.
  42. K

    Wiki E/m visit with prolonged service on separate day

    I have a coding question regarding inpatient billing. I've been looking for information in regards to this, but I have yet to find anything conclusive. Let's say a palliative care dr saw a patient on may 2, 2016 and billed for these services..let's say 99222. Then he goes back may 5, 2016...
  43. J

    Wiki Learning Inpatient Coding

    Hello, all. I have been studying inpatient coding for a long time now, and I am getting to the point where I feel confident enough to sit for an exam, and within the next few months begin applying for an inpatient position... even still, I have moments that I have a question about something that...
  44. P

    Wiki ECMO Management codes with subsequent care

    I have a question regarding ECMO: Can Dr. Smith bill ECMO management 33949 in addition to subsequent hospital care 99231-25 for the same date of service (as long as documentation supports both codes)? Thanks in advance!
  45. K

    Wiki Trilogy device

    Hi everyone I was wondering if anyone had any input on coding the use of Trilogy devices as a form of mechanical ventilation. My CDI team feels that we should be using the mechanical ventilation codes on patients with respiratory failure that are put on a Trilogy device during their stay. I...
  46. K

    Wiki Nephrology - coding inpatient

    I am new to coding inpatient hemodialysis for physicians and I have a question about documentation. When the doctor sees the patient while on dialysis, do they have to actually document, "patient seen on dialysis"? Also if they are on CRRT, is it assumed that they were seen while on dialysis...
  47. M

    Wiki Global Period Question

    Hello, If a resident or a fellow (non-billable) from Urology performs a major surgery (90 day global period), can the following days (subsequent visits) be billed by the Urology Attending physician since the Attending did not perform the surgery? Please advise. Thanks, Mary V., RHIA, CPMA
  48. K

    Wiki Nephrology

    I have a question about coding rounding for a Nephrology physician. He sees the patient on dialysis, which he documents, does he have to write the diagnosis on each progress note? Or can you go back and use the dx from the initial visit? This is for the physician fees. Thank you for any...
  49. R

    Wiki United Healthcare PHP is now IP?

    Im finding from VOBs lately that no matter the home plan, UHC is coming back saying PHP is considered Inpatient treatment, and if the facility is licensed as out patient,PHP is not covered. Is anyone else running into this lately?
  50. L

    Wiki inpatient telehealth question

    hello one of my outpatient MD has been approached to provide telehealth psy services for an inpatient unit. We utilize telehealth with outpatient but I am not familiar with doing inpatent. are any of y'all billing this service if so are you getting paid. thanks lisa