The novel coronavirus (COVID-19) pandemic has created challenges for case management departments. They must balance protecting the health of case management staff while maximizing productivity. In this new environment, departments are closely examining the role of the utilization review (UR) case manager.
Q: A child presents to the ED with a closed fracture of his left hand. The physician performs a two-view hand x-ray that shows a small fracture. The physician reduces the fracture and performs a one-view x-ray to ensure alignment. Which CPT codes and modifiers would be used to report the physician’s services?
Q: Naturally, companies are curious to learn which of their employees have been exposed to COVID-19 as the workforce begins to return to the office. Under what circumstances can healthcare providers legally disclose a patient’s diagnosis to his or her employer?
This week's note from the instructor reviews coding and documentation requirements for severe malnutrition in light of another OIG review of these types of claims.
Q: Patients who leave the hospital against medical advice (AMA) have a much higher 30-day readmission rate than patients with non-AMA discharges. What strategies can case managers use to help patients who may be at risk for leaving AMA?
The Program for Evaluating Payment Patterns Electronic Report (PEPPER) is a rich source of data. Consider how to use the PEPPER to guide coding and CDI process improvements.
