REIMBURSEMENT STRATEGIES

CODING & DOCUMENTATION

 

Fam Pract Manag. 1998 Nov-Dec;5(10):15.

What to do about Medicare overpayments

Q

In a routine chart audit, we discovered about 20 instances in which we had billed Medicare for new patient visits as “incident to” a physician's service when the patient was seen only by a midlevel provider, despite Medicare's requirement that a physician also see the new patient in such situations. How should we handle the matter of overpayments with the carrier?

You should write a letter to the carrier and explain that you found the overpayments as the result of a self-audit, identify the corresponding claims and attach a check for the amount in question. Given that the overpayments involve a relatively insignificant amount of money, the carrier should be happy to accept the check and leave it at that. If you aren't comfortable with this approach, contact your health care attorney for advice. You should also retrain staff to ensure that this type of error won't be repeated, and document these efforts and any others designed to improve compliance.

Documenting musculoskeletal findings

Q

In the musculoskeletal section of the general multisystem exam in the 1997 documentation guidelines, does “Examination of joint, bone and muscle” of one of the extremities require that we document the examination of every joint in that extremity?

No. The wording of that requirement in the multisystem exam guidelines should read, “Examination of joint(s), bone(s) and muscle(s),” as it does in the single-organ-system exam guidelines. For the lower extremity, for example, you could document either the knee, ankle or foot.

ICD-9 codes for lab work

Q

How should we code lab work that is essential in monitoring a patient who needs a high-risk medication?

Use one of the following ICD-9 codes in addition to whatever ICD-9 code describes the condition for which the medication was prescribed:

  • V58.61, Encounter for aftercare for long-term (current) use of anticoagulants;

  • V58.62, Encounter for aftercare for long-term (current) use of antibiotics;

  • V58.69, Encounter for aftercare for long-term (current) use of other medications (e.g., high-risk medications).

Coding certification for driving

Q

How should I code a visit with a patient who presents to be certified for driving?

Use the appropriate E/M code and 99080, which covers the completion of special reports that include more information than is “conveyed in the usual medical communications or standard reporting form.”

Editor's note: While this department represents our best efforts to provide accurate information and useful advice, we cannot guarantee that third-party payers will accept the coding and documentation recommended. For more detailed information, refer to the current CPT manual and the “Documentation Guidelines for Evaluation and Management Services.”

 

Kent Moore is the AAFP's manager for reimbursement issues and a contributing editor to Family Practice Management. Leigh Ann Henry is a senior associate editor of Family Practice Management.

 

Copyright © 1998 by the American Academy of Family Physicians.
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