CPT coding Profee help

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American Academy of Professional Coders *

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HI-1051

Subject

Mechanical Engineering

Date

Apr 3, 2024

Type

rtf

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3

Uploaded by ElderWater10012

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CPT coding help for OMEGA: 1. CPT G0296- Counseling visit to discuss need for lung cancer screening using low dose CT scan (LDCT) (service is for eligibility determination and shared decision making) Please do not delete the LDCT ELIG code.!!!! This is a dummy code for CPT G0296. If the coding is correct and documentation is supported you would type over it with G0296 2. CS - to be added to all COVID test until told not to. 3. GZ modififer is for non medicare services 4. Z79.01 use for long use of anticoagulant drug 5. Recommend deleting ICD 10 Z00.00 (Encounter for general adult medical examination without abnormal findings). Per ICD 10 guidelines The Z codes allow for the description of encounters for routine examinations, such as, a general check-up, or, examinations for administrative purposes, such as, a pre- employment physical. The codes are not to be used if the examination is for diagnosis of a suspected condition or for treatment purposes. In such cases the diagnosis code is used. During a routine exam, should a diagnosis or condition be discovered, it should be coded as an additional code. Pre-existing and chronic conditions and history codes may also be included as additional codes as long as the examination is for administrative purposes and not focused onany particular condition. Documentation s79.01upports a problem visit. 6. Recommend revising 99397 (PREVENTIVE VISIT,EST,65 & OVER) to G0438 (Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visit). Documentation supports AWV and patient has Medicare HMgzO per EPIC 7. "Recommend revising G0439 (Annual wellness visit, includes a personalized prevention plan of service (PPS), subsequent visit) to G0438 (Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visit). Per EPIC DOS 9/22/2020 is the first initial visit for AWV.
Recommend adding modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service). Documentation supports a wellness visit and immunizations on the same day. Recommend revising secondary and third DX code to I10 (Hypertension), E78.5 (Dyslipidemia). Per client Ensure that all HCC diagnoses will be moved on the top of the list for the claim submission. Make sure Z00.00 is 1st dx on wellness visit." 8. Recomme adding DX code Z71.84 ( Encounter for health counseling related to travel). Documentation supports patient traveling. Prescription was given to patient. 9. "Recommend to requiry the physician. G0439 was billed on a prior DOS. It has not been 1 year for AWV. G0439 was billed on 4/5/21. Please make sure you check codes to see if it has been 1 year. You can only bill G0438 or G0439 once in a 12-month period. G0438 is for the first AWV and G0439 is for subsequent AWVs. Remember, you must not bill G0438 or G0439 within 12 months of a previous G0402 (IPPE) billing for the same patient. Medicare denies these claims with messages of “Benefit maximum for this time period or occurrence has been reached” and “Consult plan benefit documents/guidelines for information about restrictions for this service.” Coder is required to query and not change E&M per client workflow. Recommend to query physician regarding E/M level. Documentation supports 2 stable chronic conditions and complexity of problems addressed is moderate, 0 tests were ordered/reviewed, data is minimal, prescription drug management, risk is moderate, the overall MDM is moderate. Final decision based on 2 out of the 3 elements at the same level or higher. Documentation supports 99214" Queries:
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