Advanced Coding and Billing Support for the Urology Office

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Forum

Each Staff Member will be Provided Unlimited Access to the Support Forum for One Year, via their Personal PRS Network Account

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Sample Question

Topic: Chronic Care Codes

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Question

Hi, Do you have any Advice on getting started with billing the CCM Codes, 99490, 99487 & 99489?
Specifically in regards to documentation on Time spent (what, who, how?)
For 99487, it appears that the MD has to be directly involved with the care for that month including MDM. (is that your interpretation as well?)
With this, do you think that billing 99487 would appropriate every month?
If there has not been a significant MDM or change to plan of care but the time spent does get to 60 minutes by other Clinical Staff?
I would appreciate any insight on the above questions as well as anything additional!
Thank You
Additional question on this-
In a Noridian slide deck in regards to CERT audits, under “Documentation Needs”, it states “Care plan for EACH chronic condition with measurable goals”.
Do you interpret this to mean that we must be monitoring and treating each Chronic condition? In the setting of a patient who we are treating/monitoring for a Urologic condition but also has Diabetes that could potentially alter the treatment or encompass additional monitoring of medications etc., we are not treating the Diabetes but it affects the Chronic condition that we are monitoring…
Thank You

Answer

You have two issues that must be considered before billing for CCM in addition to documenting the time and services provided that see relating to the issue noted above.
Patients must have two or more chronic conditions (expected to last at least 12 months) with significant risk of death, functional decline, exacerbation or decompensation – E.g., hypertension, heart disease, diabetes, high cholesterol, etc. Only one provider (who wrote plan of care) allowed to bill monthly Spent at least 20 or 60 minutes or more (every 30 days) coordinating care
For the diabetic patient managing the diabetes in addition to the Urologic condition would put you potentially into managing two chronic conditions but managing only the Urologic condition would not.
An additional consideration is the for the diabetic patient it is likely that another provider is billing for the CCM of that condition and any others the patient may have including the Urologic condition if coordinated with your Urologist. Make sure that you are in communication with the other providers before reporting the CCM codes. You may be able to bill first and get paid but it may result in some hard feelings from a referral source. Consider both the politics and the overall revenue of all patients in each case.

ICD-10 Topic: Hormone Sensitive Prostate Cancer

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Question

Would it be appropriate to presume a patient has a hormone sensitive prostate cancer (C61 & Z19.1) if he received a Lupron injection – before/without knowing how his cancer will respond to the Lupron?

Answer

As with all ICD-10 codes it is the physician/practitioner that is allowed to make the final call on appropriate Dx. The real answer to the question must be to check with the provider and ask for his/her definitive Dx.
Coding Opinions for consideration below:
Most treatments are based on percentage of success. I would be inclined to believe that most providers would believe the CA to be hormone sensitive when using LHRH as the next line therapy. And use of the Z code is appropriate until proven otherwise.
Not all LHRH injections are given as next line therapies. If the LHRH is being used as staging for radiation therapy then the Z code should not be applied.

Learn

Each Staff Member will have Unlimited Access to Educational Videos for One Year, via their Personal PRS Network Account

  • 22 coding presentation videos by Dr. Ray Painter
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  • Videos are 20 minutes or less
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  • Arranged by topic:

Documentation, Coding and Billing E&M Modifier -25
Coding Simplified -78, -79, -58
Office E&M Bundling Rules
Office Scenarios Unbundling Modifiers
Facility Based Coding Unbundling Scenarios
Facility E&M Scenarios Other “Same Day” Modifiers
Time Based Charges Same Day Modifiers Scenarios
Time Based Charges Scenarios Surgical Assist
Time Based Charges - The Bottom Line ICD-10 Structure
Global Concepts How to find an ICD-10 Code
E&M Modifier -24 ICD-10 Scenarios

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Do You Really Know Urology Coding and Billing?

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