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Question

I am board certified both as an internist and as a different specialty. Am I allowed to refer patients to myself for consultation so that I may bill for an initial consult code when addressing the other specialty problems?

No. A consultation is a request for an opinion from one healthcare provider to another healthcare provider. The claim would never be approved because block 17 on the claim must show the name and Unique Provider Identifier Number of the requesting physician when a consult code (99241-99255) is billed. That name and number cannot be the same as the provider who is billing for the service.

Question

I made a home visit to a Medicare patient and received a denial for the claim I submitted because I was not the "hospice" physician. How can I be paid for the home visit?

You need to use modifier "GV" as the visit code on the claim. Modifier GV indicates "attending physician is not employed or paid under agreement by the patient's hospice provider."

Question

As internists, we perform ventilator management when seeing in-patients at the hospital. When we bill the vent management codes 94656 and 94657 in addition to daily care hospital codes 99231 to 99233, we receive denials for ventilator management from Medicare, saying they are "bundled." How can we be paid for both, and how can we learn about bundling?

You cannot be paid for both on the same day because the ventilator management codes are bundled into the E&M (daily care) codes by Medicare and many private carriers.

Visit the Centers for Medicare and Medicaid Services web site (http://www.cms.hhs.gov/medlearn/ncci.asp) to view the Correct Coding Initiative, which lists all of Medicare's "bundles."

Question

I found an old Medicare check that I have not cashed. It says that it's void after 60 days. Will they issue a new check to me?

Yes. Call Medicare and they will issue a new check.

Question

We use a patient-activated cardiac event monitor. We hook up the patient, run a baseline, and bill code 93270 for the service. We've been told by a company that we cannot bill for this code since we have the patients remove the monitor from themselves and mail the monitor back to the company. How can we bill for the hook-up and the time the nurse spends transmitting a baseline to the receiving station?

You've been given some incorrect information. There is absolutely no requirement in the CPT code book or Medicare Carrier Manual that says you have to be the one to disconnect the leads from the patient in order to bill for the hook-up code 93270.

For complete billing instructions on cardiac event monitors, visit my web site at www.donself.com.

Question

The 1995 and 1997 Evaluation and Management documentation guidelines do not say if I can use a check-off template for my progress notes. Is this legal?

It is legal, and most consultants recommend it. The template is beneficial by allowing you to document the higher levels of services in less time. You'll find that this simplifies the process of documentation.

Also, if you check the "abnormal" box on the form, be sure you specify what is abnormal.

Don Self is an expert in Medicare coding and has been educating health professionals for 14 years through consultations and seminars. . All questions will receive a personal answer, and some will be published. No fee is charged for single questions; a consultation fee may be charged for multiple questions.

# posted by Medical Information : 2:57 AM