Our experts answer questions about hitting MUEs on injections and infusions, setting multiple prices for the same CPT codes, payment rates for cancer centers, and more.
Sally, a case manager assigned to surgical cases, has noticed a recent increase in challenging insurance cases since her hospital brought on a new trauma surgeon. One such challenging case began Christmas Eve, when an 80-year-old female patient with several fractures was admitted to Sally’s unit. The patient shared with Sally that her injury occurred when she tripped while exiting a major super store. She fell face first on an icy sidewalk. She had just finished her holiday shopping and all her presents were scattered in front of her. The ambulance drivers had been so accommodating. Before transporting the patient, they collected all the gifts and delivered them to the nearest hospital with the patient.
How we define, diagnose, and document diagnoses that predict morbidity and mortality is essential if we want our patient’s risk to be accurately portrayed.
