Managers should not assume that they can review every guideline, every item in Coding Clinic, or every coding-related issue targeted by the Office of Inspector General or Recovery Auditor.
One area of CPT coding that saw big changes for 2017 is for dialysis circuit coding. The existing codes have all been deleted, and new codes have been created (36901-36909) for reporting these procedures.
Mrs. Gray, a 93-year-old is in the ICU, has been diagnosed by her physician as having chronic heart disease that has progressed to “end stage.” The physicians set up a meeting at the patient’s bedside to discuss this prognosis with her and invite a representative of every member of the healthcare team to participate. Among those attending the meeting were the nurse case manager and social worker, who makes sure a representative from spiritual care is also present. Since the patient has told them that she has no family or friends, which the social worker validates after an extensive investigation, there are no significant others to attend. Mrs. Gray is truly the last living member of her family.
Back in May, CMS put a hold on short-stay inpatient audits related to the 2-midnight rule. That hold was lifted effective September 12, 2016, according to a FAQ published by CMS as CMM reported last month. Our readers are wondering, however, about the latest information when it comes to these reviews. We reached out to Ronald Hirsch, MD, FACP, CHCQM, vice president of the Regulations and Education Group at Accretive Health in Chicago, to give us the latest update.
