• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Nursing home level of service

C

cbooker

Guest
Messages
37
Location
Harrisburg, PA
When performing audits for several nursing home visits they are auditing out to a higher level due to the documentation of medical decision making. When discussing this with the provider he chooses the level based on the nature of the presenting problem.

Has anyone else had this issue. When coded they always come out to a higher level.

Which is correct way, nature of the presenting problem or the documentation?

I would appreciate any input.
 
Here's how I see it....the nature of the presenting problem is chosen before the visit (it's like a guideline that should help determine risk and set up the level of care needed) and the MDM is determined after.
Use the final MDM to drive your code. The MDM accounts for the points of final dx, actual work-up, tests ordered/reviewed/risk, etc...

In a sense, they are cousins...again....the NOPP is used to determine the appropriate level to build.

I think your doc is on the right track in wanting to bill a code that is medically necessary, but I think he misunderstands... overall the documentation determines the codes, the MDM supports it.

Does that make sense? Ha! Sorry, I am working on a nursing home audit, so you can imagine my brain is mush after 7 hours!
 
You must log in or register to reply here.
Top