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Thread: Questions resulting from recent educational audit

  1. #11
    Join Date
    Apr 2007
    Jacksonville, FL River City Chapter


    AAPC: Back to School
    1. The patient should be coded as new. It would be incorrect to do otherwise.

    2. The risk table makes a clear distinction between four types of procedures:

    a) minor procedures w/ NO identified risk factors --> LOW Risk
    b) minor procedures WITH identified risk factors--> MODERATE Risk
    c) major procedures w/ NO identified risk factors-->MODERATE Risk
    d) major procedures WITH identified risk factors--> HIGH Risk

    First determine if a procedure is minor vs. major. Then determine if any risk factors specific to this patient and indicated in the record exist for the procedure.

    3. If the "presenting problem" RISK is already HIGH due to the presence of severe exacerbation/side effects, you already have a HIGH overall Risk level (which is determined by the highest Risk subcomponent level.) No need to debate whether certain rx drugs can be bumped to a higher level than indicated on the table.

    4. According to the Marshfield tool, 2 "Amount/Complexity of Data" points can be assigned for the summarization of a discussion with another provider.

    5. 1997 Exam bullets can be credited in almost all cases when only one component of the bullet has been performed. Documentation of a finding regarding the eyelids would receive credit for the bullet. True, the bullet says "conjunctiva and lids," but the "and" just refers to the fact that this single bullet includes credit for examining both the conjunctiva and lids. No separate credit is given for each. It does NOT mean that both must be documented to receive credit for the bullet. The only exception to this rule is a case where the bullet has a specific numeric requirement, as with the vitals bullet in the Constitutional system, which requires "any three of the following seven..."

    This is not a point requiring interpretation. It is given in black-and-white in the guidelines. To confirm this, access the 1997 E/M Doc. Guidelines here, and refer to the 2nd paragraph on p. 13 which says:

    Documentation for each element must satisfy any numeric requirements (such as “Measurement of any three of the following seven...”) included in the description of the element. Elements with multiple components but with no specific numeric requirement (such as “Examination of liver and spleen”) require documentation of at least one component.

    Seth Canterbury, CPC, ACS-EM
    Last edited by SCanterbury; 01-14-2010 at 08:34 AM.

  2. #12
    Join Date
    Apr 2007
    Sacramento, CA



    I recently had a provider ask me if a new immunization given could be counted as "moderate risk". I'm inclinded to say minimum risk, but what do you think?


    Susan Ayres, CPC
    Susan Ayres, CPC

  3. #13
    Join Date
    Apr 2007



    From the bottom of my heart, Thank you! I'm so happy and relieved to have that paragraph pointed out to me. I'm actually looking forward to the memo I'm sending my docs this morning that will start out with "I was quite mistaken..." Thanks again.


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