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"As we see it, the indication to perform this procedure was that the stone was in the ureter. The fact that it was accidentally knocked back into the kidney is inconsequential," write Jonathan Rubenstein, MD, and Mark Painter.
"First... you have to determine if you are in a global period," write Jonathan Rubenstein, MD, and Mark Painter.
"Category III codes are designated as temporary codes by the AMA. Even though the codes are considered temporary, they are an integral and important part of the system," write Jonathan Rubenstein, MD, and Mark Painter.
Jonathan Rubenstein, MD, and Mark Painter address the coding question: My local hospital tells me that starting Jan. 1, 2020, I have to consult a Clinical Decision Support Mechanism due to the Appropriate Use Criteria program. I thought that didn’t start until 2021. Can you help?
"By creating time-based codes, one can most accurately describe and be reimbursed for the amount of time and effort spent face to face with an individual patient," writes Jonathan Rubenstein, MD, and Mark Painter.
Urology will make a modest gain overall in the 2020 final rule for the Medicare Physician Fee Schedule, although the truly significant changes won’t be felt until 2021.
"If the specific time spent discussing the disease and the appropriate treatment was not documented, then be sure that your documentation meets the criteria (history, physical examination, and medical decision-making) separate from any criteria performed to make sure the patient was prepared and able to have the procedure," write the Painters.
"One of the common issues we have noted for urology practices in updating ICD-10 codes is not the electronic medical record or practice management system failing to load new codes; rather, it is a failure to update templates," write Ray Painter, MD, and Mark Painter.
Documentation must support performance of ‘unusual services,’ according to Ray Painter, MD, and Mark Painter.
"There are two major reasons for you to confirm accuracy: to be sure that fraudulent claims are not being submitted and to confirm that the claims accurately reflect the work you have performed," write Ray Painter, MD, and Mark Painter.
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