1. Brenda Weedman
   Posted 3 months ago #
   

   Our office is questioning the billing of multiple body part problems during the same visit with the same physician for a Medicare patient

2. SuperCoder
   Posted 3 months ago #
   

   I gather you're talking about double dipping on body areas or organ systems being counted for HPI and exam? So if you have runny nose spots on throat, he wants 2 points -- 1 for nose and one for throat even though nose and throat both fall under ENMT -- ears, nose, mouth and throat. This is a definite no-no. My suggestion is to explain that the Office of Inspector General has identified Evaluation and management levels as a target are for 2012. Meaning insurers will be doing mini probes, looking for outliers, and doing mini probes -- requests for documentation on specific codes to analyze if their is probable miscoding. To protect the physician from major paybacks, you want to help him improve his coding accuracy. Show him the audit worksheets and explain this is how auditors count the systems. Any double dipping can lead to requests for paybacks and additional penalties due to coding higher levels of EM services than supported.

   Here are some links to support your concerns:

   https://www.highmarkmedicareservices.com/faq/partb/pet/lpet-evaluation_management_services.html#4
   Under the Examination Section of the 1995 Scoresheet, can we combine the body areas and organ systems?
   No. The examination section of the 1995 score sheet is divided into body areas and organ systems. The Current Procedural Terminology (CPT) manual recognizes 7 body areas and 12 organ systems. Depending on the documentation in the patient's medical record you can use either the body areas or the organ systems. There is a dotted line between the body areas and organ systems indicating you must choose one or the other. If you combined the body areas and organ systems you would be giving credit twice which would be incorrect when determining the final score for the examination section of the score sheet. An example could be: the documentation in the patient's medical record stated, abdomen soft, credit can only be given in the body areas under abdomen or in the organ systems under Gastro Intestinal (GI) which ever area benefited the physician the most.
   Scoresheets
   https://www.highmarkmedicareservices.com/em/scoresheets.html
   http://www.e-medtools.com/Aqua_Medicare_Coding_Worksheet.html

   Jen Godreau, CPC, CPMA, CPEDC

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