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For Traditional MIPS you must submit 6 quality measures. You can earn up to 10 points for each quality measure. This means your maximum score for quality in the MIPS program is 60 points. Many providers automatically assume that if they have a performance of 95% on a MIPS quality measure, they will earn 9.5 out of a possible 10 points for that measure. That assumption is not always true.

“My group takes “call” at our local hospital, and this necessitates seeing patients in the emergency room (ER) on occasion. We are not all in agreement regarding what E/M codes should be used in this scenario. We have come up with different encounters: 1. A patient seen in the ER. The patient is then discharged to follow up for outpatient care. 2. A patient is seen in the ER and then admitted for continued medical treatment. 3. A patient is seen in the ER and is taken straight to the operating room for surgical treatment. What E/M code series would you recommend using for these different scenarios? Thank you for the help!”

FDA Recalls May 27 - June 1, 2024

“Do you have any advice on coding for a return to the operating room within the 90-day postoperative global period for revision of the prior procedures that were performed? The patient had a 1st metatarsocuneiform joint (MTCJ) fusion and 2nd toe, proximal interphalangeal joint (PIPJ) fusion for a hammertoe. Post op x-rays demonstrated excellent fixation and alignment. The patient returned 2 weeks later and had obvious abnormal clinical changes to position of the fusions. X-rays showed loss of position correction at the 1st MTCJ fusion and the 2nd toe fusion as the two-component implant had disengaged and dislocated. The patient didn’t recall any injury. This required a return to the OR for revision of the fusion of both joints done three weeks post operative. The 1st MTCJ plate and screws were removed, the joint realigned and a new plate/screw construct applied. The 2nd toe PIPJ was opened, and the two-component implant re-engaged for alignment correction. Is the following coding scenario 28740 -78, CPT 28285 -78 correct to bill?”

FDA Recalls May 20 - 26, 2024

Do I need to have a referral to provide Routine Foot Care to a patient in a Nursing Home?