I'm getting ready to fight an uphill battle and I would love to have some opinions before I do.
I see some of the stuff they try to bill as consults and think no wonder CMS plans on no longer paying for them.
Example #1
REASON FOR CONSULTATION: Possible coronary artery bypass surgery
candidate
To me, this is pretty clearly a transfer of care. The cardiologist that did the cath which showed the 90% blockage sent the patient to one of my CVT surgeons. The above is from the "consult" note. The documentation supports a level 3 consult or a level 1 admit. I think this should be an admit, the cath was done outpatient, CVT sees patient they go inpatient and have surgery 3 days later.
Example # 2
REASON FOR CONSULTATION: Loculated pleural effusion with
possible trapped lung. We were consulted for possible
decortication.
Again, seems pretty clear this is a transfer of care. My favorite part about this one is there is no requesting provider listed. He does end the note with a thank you for the consult but I have no idea who he is thanking. The referring physician listed for billing isn't even one that saw the patient during this admit and is not his regular physician.
These were not coded by the surgeons, they were coded by an outside company. I have huge stacks of errors this company has made and continues to make. I have finally been able put a billing hold on all coding done by them, but I don't know how long that will last.
I am continually showing them these types of errors and the powers that be won't cut them loose. I guess I just wanted to get others opinions, am I being unreasonable or is this as bad as I think it is? This practice is about 85% medicare patients.
Thanks for any opinions or advice,
Laura, CPC, CEMC
I see some of the stuff they try to bill as consults and think no wonder CMS plans on no longer paying for them.
Example #1
REASON FOR CONSULTATION: Possible coronary artery bypass surgery
candidate
To me, this is pretty clearly a transfer of care. The cardiologist that did the cath which showed the 90% blockage sent the patient to one of my CVT surgeons. The above is from the "consult" note. The documentation supports a level 3 consult or a level 1 admit. I think this should be an admit, the cath was done outpatient, CVT sees patient they go inpatient and have surgery 3 days later.
Example # 2
REASON FOR CONSULTATION: Loculated pleural effusion with
possible trapped lung. We were consulted for possible
decortication.
Again, seems pretty clear this is a transfer of care. My favorite part about this one is there is no requesting provider listed. He does end the note with a thank you for the consult but I have no idea who he is thanking. The referring physician listed for billing isn't even one that saw the patient during this admit and is not his regular physician.
These were not coded by the surgeons, they were coded by an outside company. I have huge stacks of errors this company has made and continues to make. I have finally been able put a billing hold on all coding done by them, but I don't know how long that will last.
I am continually showing them these types of errors and the powers that be won't cut them loose. I guess I just wanted to get others opinions, am I being unreasonable or is this as bad as I think it is? This practice is about 85% medicare patients.
Thanks for any opinions or advice,
Laura, CPC, CEMC