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Nursing home level of service

  1. #1
    Harrisburg, PA
    Unhappy Nursing home level of service
    Medical Coding Books
    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.

  2. #2
    Kansas City, MO
    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!
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC,CCC, AAPC Fellow
    PMCC Licensed Instructor
    2018 Chapter President, Kansas City, MO

  3. #3
    Harrisburg, PA
    Thanks for your input.

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