News

The purpose of these changes is to support individuals’ engagement in their care, remove barriers to coordinated care, and reduce regulatory burdens on the health care industry.

“In a nursing home, if you are rendering a service where the E/M is a systemic condition and separately identifiable, can you bill the E/M code and the procedure? I believe you cannot. My biller and a webinar speaker both feel that you can. Their thought is that as long as you have different diagnoses for the office/nursing home visit and routine foot care, it will be allowable. For example, you could bill E/M 99307, CPT 11056, and CPT 11721 and the diagnosis codes are G20 (Parkinsons), L84 (corns and calluses), I73.89 (PVD), B35.1 (mycotic nails), M79.674 and M79.675 (pain toes). I would put the G20 on the E/M 99307, L84 and I73.89 on CPT 11056 and B35.1 and M79.674, M79.675 on CPT 11721. Any thoughts on this issue would be helpful.”

FDA recalls on drugs, medical devices, food & beverages, and animal & veterinary December 8 -16

in order to be HIPAA Compliant, you must maintain a "Culture of Compliance" at your office. This can include keeping your software up-to-date, regular required training and addressing risks that pose to your office. This month we address dedicating a privacy officer, testing your backups and proper disposal of patient records.

FDA Recalls on Animal and Veterinary, Drugs, Food & Beverages and Medical Devices

“This past summer, one of my patients who was suffering from a diabetic foot ulcer was admitted to a skilled nursing facility (SNF) following a hospital discharge. During her admission to the SNF, I continued to care for her in my office, including ulcer debridement and radiographs. Medicare is denying payment for her ulcer debridements (CPT 97597) as well as the technical component of her radiographs (CPT 73630-TC) on the grounds that “all SNF Part A inpatient services are paid under a prospective payment system (PPS)” and that “services that are considered within the scope or capability of SNFs are considered paid in the PPS rate.” In other words, Medicare considers the care that I rendered to be bundled with the payment to the SNF for admission, and therefore the SNF should have been doing it themselves, and that if I want payment I need to bill the SNF since they–in Medicare’s view–outsourced the ulcer care to me. While I fully expect the SNF to balk at any requests for payment from me, and I believe it might still be worth my time to appeal to an Administrative Law Judge, I would like to know if anyone has experienced this? In the future, if I am going to care for the ulcers of my patients when they are admitted to SNFs, is there anything I can arrange with the SNF or with the patient to ensure I am compensated for their care?”