Hi Everyone,
I received the email below form of my MIPS clients and not sure what to tell them. Can someone assist me with this?
"
Our understanding is that when a patient has a longstanding PVD in one eye (e.g., OD) and presents with an acute PVD in the fellow eye (OS), the diagnoses should be kept separate, with the acute designation applied only to the affected eye (e.g., PVD OD; PVD OS, acute). At the follow-up visit, the acute designation is removed, and the diagnosis is combined into a single bilateral PVD code.
We have recently been informed that certain payers, particularly Humana and Molina, are issuing denials when bilateral conditions are split into unilateral diagnoses. This creates a challenge when splitting the diagnosis solely to meet the MIPS measure requirements. We would appreciate any guidance on how best to address this issue, or insight into how other practices are managing compliance with both MIPS and payer coding requirements in this instance."
Thank you,
Sherry
I received the email below form of my MIPS clients and not sure what to tell them. Can someone assist me with this?
"
Our understanding is that when a patient has a longstanding PVD in one eye (e.g., OD) and presents with an acute PVD in the fellow eye (OS), the diagnoses should be kept separate, with the acute designation applied only to the affected eye (e.g., PVD OD; PVD OS, acute). At the follow-up visit, the acute designation is removed, and the diagnosis is combined into a single bilateral PVD code.
We have recently been informed that certain payers, particularly Humana and Molina, are issuing denials when bilateral conditions are split into unilateral diagnoses. This creates a challenge when splitting the diagnosis solely to meet the MIPS measure requirements. We would appreciate any guidance on how best to address this issue, or insight into how other practices are managing compliance with both MIPS and payer coding requirements in this instance."
Thank you,
Sherry