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What are CMS requirements for post-operative reports?

08/22/2016

The following is an excerpt from CMS’ interpretive guidelines for its hospital surveyors, State Operations Manual Appendix A, Tag A-0959, Surgical Services Condition of Participation: §482.51(b)(6).

Withstand scrutiny of immediate post-op notes with this template.

08/22/2016

This sample template for immediate post-op notes is courtesy of Pikeville (Ky.) Medical Center. Pikeville leadership requires physicians to complete this form before the patient goes to the next level of care unless accompanied by the practitioner who did the procedure. Full post-operative reports should be completed according to hospital policy.

Warn physicians of the increasing scrutiny of hospital post-op notes

08/22/2016

by: A.J. Plunkett

Tell your physicians to expect more scrutiny of their post-operative records and more demand for immediate progress notes as CMS and The Joint Commission (TJC) crack down on failures in that documentation. Failure to comply may result in pressure from hospital leadership.

CMS on diabetes program: 12-month billing delay, no ceiling on payments

08/22/2016

by: Roy Edroso

Among the clarifications made on a CMS call about the proposed Medicare Diabetes Prevention Program (MDPP): Suppliers and providers will need a 12-month head start on the program before they can bill Medicare for it.

To get assistant paid on '0' claims, tell why they’re needed

08/22/2016

by: Roy Edroso

Question: For CPT codes with an indicator of 0 (Assistant only allowed with supporting documentation), how do you recommend the surgeon document the need for an assistant? On our claims we have the assistant's name documented at the beginning of the op note, but then no further mention of his role throughout the procedure, and we've had several denials from Medicare after review of the records.

Default to E/M codes, check payer policies when conducting group visits

08/22/2016

by: Richard Scott

Question: I have a provider who does group counseling for drug and alcohol dependence, after which the provider writes individual progress notes for each patient. Would it be appropriate to bill an E/M code based on time or is there a more appropriate code to use? The provider is not a psychiatrist.

Group visits prove challenging for practices billing prevention, intervention codes

08/22/2016

by: Richard Scott

With few options and unfavorable outcomes, providers nationally face a difficult time gaining reimbursement when providing group visits for their patients.

ICD-10-CM guidelines clarify definition of ‘with,’ when to use bilateral codes

08/15/2016

by: Julia Kyles, CPC

Review the new ICD-10-CM guidelines before Oct. 1 to finalize your preparations for the new code set. After the update, be on the lookout for denials that may be triggered by payers that are relying on outdated information.

Consider care management, EHR readiness before jumping into CPC+

08/15/2016

by: Richard Scott

Weigh several elements, including your staffing structure, your use of electronic health records (EHR) and how quickly you’re ready to embrace change to determine if you should get behind CMS’ latest value-based model for primary care.

Keep an eye out for incident-to audits

08/15/2016

by: Roy Edroso

Heads up: Some action on the physician-supervision front may warn of a clampdown on incident-to and other supervisory claims.

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