Reader questions keep us on our toes

by: Julia Kyles, CPC Aug 24, 2017

The team at Part B News and its sibling publications do more than write articles; it also answers subscriber questions, which it turns into more articles.

Here's a sample of the questions we've received recently. Answers are sent directly to subscribers and may appear in upcoming issues. Feel free to leave your own answers in the comments.

This PBN subscriber's question about documenting infusion times had us hitting the internet-only manuals:

Is the nurse manager’s documentation of stop times in compliance with CMS guidelines or should the stop times for infusion be documented by the attending nurse? Please provide citations, if possible.

Here's a two-part question that came in as a follow up to a July 10 article (paywall) about new versus established patients:

We have multiple practices. Each practice has a unique group national provider identifier (NPI), but they share a tax identification number (TIN). If a patient leaves one family medicine group and goes to a different family practice group with a diffiernt NPI but the same TIN, is the patient new or established for the new family medicine group?

A doctor who is an ob/gyn leaves one practice and goes to work at another group with a different NPI but the same TIN. A patient follows the doctor, but on her first visit she is seen by another ob/gyn. Is that patient new or established?

This question about coding office consults came in via SelectCoder, a full-service coding resource from DecisionHealth/H3.Group, PBN''s parent company:

Can you please clearly define specifically what requirements are needed to properly code an office consult and what needs to be included in the documentation?

The editor for the Anesthesia & Pain Coder's Pink Sheet - a sibling publication of PBN - is still working on an answer to this one:

Two months after a complication-free permanent neurostimulator implant the patient complained of drainage from one of the incision sites. The doctor determined the pocket site was infected and explanted the entire system. Part of the op note states:

“Sharp and blunt dissection was utilized in both areas. Full hemostasis was obtained with Bovie cautery. Up opening of the incision , yellow discharge came out. Culture was taken from the top incision ( upper thoracic incision). The internal pulse generator and the extension wire were removed from the right side above the buttock area. The anchoring device was disconnected from the epidural lead. The epidural round lead was removed intact from the epidural space. Both incisions were checked for hemostasis repeatedly. Both incisions were irrigated with sterile normal saline mixed with bacitracin. Then JP drain was placed in each of the incision. The drains were secure with 2.0 Silk. The subcutaneous tissues were approximated using 2-0 Vicryl. The skin was approximated using staples. The incision was covered by gauze, telfa and tegaderm.”

Should we report the irrigation and drainage procedure in addition to the removal of the generator and leads? If so, should we report 10060 (Incision and drainage of abscess [eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single) or 10180 (Incision and drainage, complex, postoperative wound infection)?

Our message forums are a great place to ask and answer questions, and they're open to non-subscribers. Sign up for the Medical Practice Revenue Cycle forum and the Professional Services Coding forum today.

Blog Tags: CMS

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