Patient history should be updated on follow-up visits

September 1, 2008

You can update a past medical, family, and social history (PFS) and ROS without having to rewrite it each time.

Therefore, we recommend that you include a more specific reference in your new documentation, for example: "I reviewed the complete history from Jan. 14, 2008, and there has been no change except that the patient had a heart attack 3 months ago."

A. Medicare has decided that it will no longer pay hospitals for certain complications. This new declaration should have no direct impact on physicians.

As you may know, hospitals are paid a set fee according to a fee schedule known as diagnosis-related groups (DRGs). The addition of comorbidities or complications can increase the payment for a procedure. It's the additional payment for certain complications that Medicare will not pay for in the future.

We are not aware of any decision not to pay the physician for taking care of the patient. If a physician who is not associated with the "global payment" for the procedure is asked to consult on a new problem, he should be paid.

For example, if a patient developed a urinary tract infection following cardiac surgery and the urologist was consulted, the urologist should get paid for all services rendered. Of course, the cardiovascular surgeon would receive no payment for the additional work that he might do because he is subject to the global payment rules for that procedure.

Q. How do I charge for Urgent PC? I understand that the original recommendation from the AMA suggested code 64555. Then I was told that AUA recommended the unlisted code 64999. I am currently being paid by most payers using code 64555. Should I change?

A. The AMA CPT executive committee recently reviewed the coding for Urgent PC (Uroplasty, Inc., Minnetonka, MN) and has changed its recommendation to match that of AUA. AMA is now recommending the unlisted code, 64999. This ruling will be published in CPT Assistant in the near future. (This ruling can be reviewed on http://AUACodingtoday.com/ under the affected codes, when published, if you have purchased the CPT Assistant option.)

Therefore, the correct code for Urgent PC is 64999, the unlisted code, unless a payer specifically tells you to continue to use 64555. We would strongly suggest that you get their recommendation in writing, if possible. If not, keep detailed notes on the recommendation, including names and dates. As you are well aware, payers can decide to change a code or rule as they desire.

Without specific instructions from a payer to the contrary, coding should be done according to AMA and AUA recommendations. You also should be aware that just because you're being paid does not mean you're being paid correctly.

The real concern is the possibility of a future determination that your payment was incorrect and you would be asked to repay the money.

Disclaimer: The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.