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Q: Where would I find the Medicare Rule for the following scenario: I have a patient that is coming in a recurring patient for the month of December coming to physical therapy for a fractured hip. During this month the patient also comes to the lab for testing for a diagnosis of CHF under the order of another physician. Are these to be billed as two separate encounters or is it "legal" to bill them all under the Recurring encounter. If so is there a modifier that should be used?
A: CMS defines certain type of services as repetitive services. Repetitive services furnished to a single individual by providers that bill institutional claims shall be billed monthly (or at the conclusion of treatment). Medicare Claims Processing Manual, Chapter 1, 50.2.2 states that "If a non-repetitive OPPS service is provided on the same date as a repetitive service, report the non-repetitive OPPS services, along with any packaged and/or services related to the non-repetitive OPPS service, on a separate OPPS claim. For example, if a chemotherapy drug is administered on a day a repetitive service is also rendered, report the chemotherapy drug, its administration, its related supplies, etc., on a separate claim from the monthly repetitive services claim. Similarly, a physical therapy treatment (which is a repetitive service because it is reported under a revenue code on the repetitive service list) is administered on the same day an outpatient consultation and a CT scan are furnished, report the physical therapy service on the claim with the other physical therapy services provided during the applicable month. Report the visit for the consultation and the CT scan on a separate claim."
Based on this CMS guideline, the laboratory test performed for this patient should not be combined with this patient's recurring physical therapy services claim.
-June Wang, MS, RHIT, CCS, CCS-P
Q: I'm coding a new resident who had a traumatic pelvic fracture. I know how to code that but what is troubling me is finding an appropriate code for a pelvic hematoma. How do I locate a code that isn't related to child birth? This only occurred in the present not during child bearing. This resident lost a lot of blood as a result and had several units given while in the hospital.
A: There really is no way to specifically represent pelvic hematoma from an ICD-9-CM coding standpoint. 867.6 is the closest code that can be obtained by indexing Hematoma, pelvis, traumatic, specified organ NEC.
-Christina Benjamin, MA, RHIA, CCS, CCS-P
Q: A patient had to come back into the office and have a repeat pap smear because the previous one was mislabeled. What diagnosis would I use for the repeat collection? The first exam was the patient's yearly screening.
A: Since the repeat test was due to an internal error and not a medical reason, most payers will not pay for a second test, denying it as not billable to the payer or the patient. If a code is needed to allow closure in a medical record and/or billing system, the code for routine screening would still need to be used as this is the intent of the test.
-Kelley Haddox, RHIT, CCS