hkatie
Networker
We recently completed an in-house documentation review and several questions came up which I'm hoping you folks help me with. If you would prefer to just point me in the right direction, that's fine too.
1. Is CPT's "Decision Tree for New vs Established Patients" absolute? If a doctor saw a patient four years ago, but would still like to bill the patient as an established patient, is that okay? I found CMS' statement on it, but I'm wondering what others' perspective is. I have a physician who would like to to choose.
2. I recently took an auditing workshop run by the AAPC during which I was given a rough guide to selecting risk from the DG's Table of Risk. It was suggested (as a starting place only) to put surgeries with a 10 day global period in the "Low" category and those with a 90 day global period in the "Moderate" category. I have one physician who has deep misgivings about this approach and feels that "Moderate" is a better starting place for all surgeries, including liquid nitrogen destructions (we are a derm practice.) Any thoughts?
3. Although prescription drug management falls on the "Moderate" level of the Table of Risk, would it be fair to put Accutane, methotrexate, and gabapentin on the "High" level given that they are used for "one or more chronic illnesses with severe... side effects of treatment"?
4. In determing complexity of MDM, we used the Marshfield tool. One physician wanted to know if there was anywhere he could "score" more points when he invites his partners into an exam room to discuss a challenging case. Any thoughts?
5. In counting exam bullets, can a bullet be counted as complete if some, but not all, of the elements of that bullet are documented? (i.e. would I count "eyelids" if that is all that is documented or does it specifically have to say in the chart "eyelids and conjuctivae"?)
Thanks in advance for any help. I do so appreciate it.
1. Is CPT's "Decision Tree for New vs Established Patients" absolute? If a doctor saw a patient four years ago, but would still like to bill the patient as an established patient, is that okay? I found CMS' statement on it, but I'm wondering what others' perspective is. I have a physician who would like to to choose.
2. I recently took an auditing workshop run by the AAPC during which I was given a rough guide to selecting risk from the DG's Table of Risk. It was suggested (as a starting place only) to put surgeries with a 10 day global period in the "Low" category and those with a 90 day global period in the "Moderate" category. I have one physician who has deep misgivings about this approach and feels that "Moderate" is a better starting place for all surgeries, including liquid nitrogen destructions (we are a derm practice.) Any thoughts?
3. Although prescription drug management falls on the "Moderate" level of the Table of Risk, would it be fair to put Accutane, methotrexate, and gabapentin on the "High" level given that they are used for "one or more chronic illnesses with severe... side effects of treatment"?
4. In determing complexity of MDM, we used the Marshfield tool. One physician wanted to know if there was anywhere he could "score" more points when he invites his partners into an exam room to discuss a challenging case. Any thoughts?
5. In counting exam bullets, can a bullet be counted as complete if some, but not all, of the elements of that bullet are documented? (i.e. would I count "eyelids" if that is all that is documented or does it specifically have to say in the chart "eyelids and conjuctivae"?)
Thanks in advance for any help. I do so appreciate it.
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