Question Exam's deferred due to COVID 19

tamil_u

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I code mainly E/M visits at the hospital and many of my providers are deferring doing an exam stating something like, "Exam deferred due to suspicion of COVID19 and lack of PPE". I don't think I can count anything other than the vitals on the exams, even with that terminology of explaining why the exam wasn't performed. What do you all think?
 

thomas7331

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I agree with you - you can only count what is documented. There has never been any guidance given, that I'm aware of, that allows for credit for exam components not performed. During these exceptional circumstances and because of situations like you describe, I believe that some providers are relying more on the use of time for coding of E/M levels, when appropriate.
 
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We are running into our providers not going into a hospital room because the patient is positive for Covid19. They are reviewing the charts and documenting that, but I don't think I can bill the E&M codes since it's not a face to face and the code description reads "time at bedside and time on the floor or unit" I can't find any codes that would justify what to bill. Any help or advice regarding this??
 
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@lacepaint01 Hello. My providers are doing the same. As biller, coder, & auditor, I'm just not sure about billing & reimbursement without a face-to-face encounter. Maybe bill the unlisted E&M? I'm not sure.
 
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@orjhns- I agree, I'm not keen on billing those codes without the face-to-face. All the information I can find is specific to providers caring for the patient directly for COVID19. We are cardiologist, so that's not us. I will look into the unlisted E&M code. Thank you
 

thomas7331

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CMS does require E&M services which are billed based on time (when greater than 50% of the time is spent in counseling/coordination of care) to be face-to-face time when performed in the office setting, but for the inpatient hospital, it may be based on floor time. See Medicare Claims Processing Manual, Chapter 12: In an inpatient setting, the counseling and/or coordination of care must be provided at the bedside or on the patient’s hospital floor or unit that is associated with an individual patient. The requirement that the encounter be face-to-face or in the presence of the patient is only specified for the office setting.
 

mmckenna

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I am with an ortho/PM&R practice in NJ. One of the PM&R physicians wants to visit an elderly Medicare patient in his home for a scheduled knee injection. The patient is in pain, with difficulty ambulating. The physician does not want the patient to come to the office due to current COVID-19 crisis. I cannot find anything on providing a procedure such as injection in POS 12. Anyone have any resources I can refer to? Thank you and be safe!
 

tamil_u

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My providers are in the room with the patient doing HPI & ROS but they defer the exam so they don't have to be within 6 ft of them. Though I would think they could still do Appearance, Alert & Oriented, ect, but they aren't at this time. Thanks for the replies.
 
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