Good Afternoon,
I work for an urgent care organization and we average roughly 60 referrals per day. I reviewed the CMS 2014 E&M guidelines and under the MDM section for "Number of Diagnoses and/or Management Options":
If referrals are made, consultations requested, or advice sought, the record
should indicate to whom or where the referral or consultation is made or from
whom advice is requested.
I don't see where this actually calculated in the MDM tables. I was looking at the 2016 CPT Code Changes and the prolonged services caught my attention. For example, we had a workers comp patient present a hand injury that required same day surgery. Our nursing staff was tied up over an hour on the phone trying to find a hand surgeon in the area that was willing to take the patient on the same day.
How do we get reimbursed for the time spent working on referrals? Is it part of the MDM and if so, how is it calculated? Can the nursing time spent working on the referrals be billed under the new code 99415 prolonged clinical staff services with physician or other qualified healthcare professional supervision?
Does anyone have insight or information that I can share with my management?
Thanks in advance!
Dana
I work for an urgent care organization and we average roughly 60 referrals per day. I reviewed the CMS 2014 E&M guidelines and under the MDM section for "Number of Diagnoses and/or Management Options":
If referrals are made, consultations requested, or advice sought, the record
should indicate to whom or where the referral or consultation is made or from
whom advice is requested.
I don't see where this actually calculated in the MDM tables. I was looking at the 2016 CPT Code Changes and the prolonged services caught my attention. For example, we had a workers comp patient present a hand injury that required same day surgery. Our nursing staff was tied up over an hour on the phone trying to find a hand surgeon in the area that was willing to take the patient on the same day.
How do we get reimbursed for the time spent working on referrals? Is it part of the MDM and if so, how is it calculated? Can the nursing time spent working on the referrals be billed under the new code 99415 prolonged clinical staff services with physician or other qualified healthcare professional supervision?
Does anyone have insight or information that I can share with my management?
Thanks in advance!
Dana