Wiki Billing Question - Help!

[Love Coding!]

Good morning Forum!

1. Some of our physicians use lab values instead of dictating the actual diagnosis. Like for example they will list the patient’s elevated blood pressure and bill it for Hypertension. Or they will document the patients CO2 level and bill it for Metabolic Acidosis. By the way I am in Nephrology. It is my understanding that some auditors and coders are not clinical. Where can I find it in writing that the physician can or cannot do this?

2. I am also finding that the physicians will bill for diagnosis that are listed in the HPI but does not reflect in the assessment/plan. For example, they will say in the HPI that the patient has Hypertension and bill for it, even though they are not doing anything for it. Can a physician bill for such diagnosis'?

Much appreciated!

GeminiCoder74

 

[mambocoder]

try the CMS guide

You've got a challenge here. There may be specific verbiage in your provider contracts to this effect, but otherwise check the CMS 1997 and 1995 documentation guidelines. There is also usually a state statute that talks about minimum documentation requirements. Look for something that says regulation Of Medical Professions or something similar in your state legislature site.

I would speculate that is the BP is consistently high, and is documented as HTN earlier in the chart, then billing HTN is ok. It makes a difference in how the doc makes decisions, regardless of the tx itself (medically managed).

If there is no definitive diagnosis, then using the symptoms or previous diagnosis is appropriate billing.

I hope that helps.