Q: We recently had a consultant recommend that we create evaluation and management (E/M) levels for our labor and delivery observation cases, similar to our emergency room levels. Does anyone do this? If so, would you be willing to share your criteria and logic used?
On January 29, NAHRI presented its first members-only quarterly call of the year, where members heard from revenue integrity experts on engaging clinical staff, chargemaster updates, and addressing denials at their root cause.
A Comprehensive Error Rate Testing (CERT) study showed that insufficient documentation causes most improper payments for observation and inpatient care services, according to the January 2019 Medicare Quarterly Compliance Newsletter.
CMS released additional instructions to the Medicare Claims Processing Manual for the accurate interpretation of claim edits and assignment of modifiers -59 and -91 on Medicare Part B claims.
CMS recently released the 2019 NCCI Policy Manual for Medicare Services, which includes updates to payment policies and coding methodologies effective January 1.
Q: The physician documented debridement (11043x1 & 11046x4) of a wound 85.25 sq. cm and documented 20 sq. cm of skin substitute application (15271). My coder says that 11043/11046 is included in 15271 and we can't separately bill for them with 15271. Do we bill 15271 as the size of the debridement documented or only the size of the skin substitute?
