What Are The RRR Rule in Coding Consultations?

RRR Rule in Coding Consultations:

Evaluation and management (E/M) codes are among the major categories of codes that are frequently examined by third-party insurance auditors. Medicare auditors recently have seen many cases in which documentation guidelines are not followed adequately to support a consultation code.Know More At: Medical Coding Training

The key reason the documentation is scrutinized is that the reimbursements for consultations are higher than the reimbursement levels for office visits of similar documentation levels. In most instances, if the guidelines were not accurately followed, the consultation was either down coded or denied. In either case, money is taken back from the practice or the physician.

The office/outpatient consultation codes, 99241-99245, and the inpatient consultation codes, 99251-99255, may be used for either a new patient or an established patient. The inpatient consultation codes may also be used for places of service, such as nursing homes or a rehabilitation facility.

When physicians code a consultation, they should follow the three Rs:

Request:

The consulting physician should receive a written request, including the reason for the consultation, from an appropriate source. Be sure it is documented properly and placed in the patient's medical record, as well as in the requesting physician's plan of care. If the physician is documenting in the chart by hand, the notes must be legible. If the notes are not legible, the visit will be treated as though there was no documentation and the visit did not happen, or the physicians will have their money taken back because the visit should not have been paid.

Before the consultation visit takes place, remember to follow this dual documentation process: The requesting physician, as well as the consulting physician, should enclose the request and the reason for the consultation and document it in each of their charts.

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Render an opinion or advice:

Here are the criteria for rendering care:

•       The medical record needs to contain documentation of the consultant’s opinion, advice and (if applicable) any services that may have been ordered or performed. CPT guidelines state that a consultant can initiate diagnostic and/or therapeutic services to help formulate an opinion. CPT instructs that only one initial inpatient consultation should be billed per hospital admission.

•       If the transfer of care will be given to the consultant to treat the problem after an opinion is rendered, each visit after the consult should be reported as a subsequent hospital visit (CPT 99231-99233). If not, care remains with the referring physician for treatment and follow-up.

•       If the consultant can’t complete an opinion on the initial consult day, or if the referring physician requests the consultant to return later to provide additional advice, use follow-up inpatient consultation codes (99261-99263). You must thoroughly document additional consult days. Also, make sure you describe modifications to management options or advise on a new plan for patient care.

Report:

If the consulting physician does not share the patient's medical record with the requesting physician, then a letter must be sent to the requesting provider. In the case that the consulting physician does share the patient's medical record with the requesting provider, the report should be put on a shared record. The report should always include a thank-you letter for the consultation request and state exactly what the consultant's opinion is concerning the patient's medical problem.

What is critical Care coding ?

Critical Care :

Critical care is the direct delivery of medical care, by a physician(s), for a critically ill or critically injured patient. CMS defines critically ill and injured patients as those who are experiencing one or more vital organ failure(s) and who have a high probability of life-threatening deterioration in their condition. Critical care requires high complexity medical decision-making to assess, manipulate and support vital organ system function in order to treat single or multiple vital organ system failure.

Critical care may be provided on multiple days, even if no changes are made in the treatment rendered to the patient, provided that the patient’s condition remains critical.

Critical care DOES NOT need to be provided solely in an intensive care unit.  Critical care and other E/M services may be provided on the same day by the same physician.Know more At Medical Coding Training

 
  The following services are INCLUDED in critical care and should not be reported separately:

1)      Cardiac output measurements

2)      Chest X-ray interpretation

3)      Pulse oximetry

4)      ABGs

5)      EKG interpretation

6)      Gastric intubation

7)      Transcutaneous pacing

8)      Ventilator management

9)      Peripheral venous access

     10)  Arterial puncture  

The Key Elements of Critical Care:

 

1)99291

 

2)99292

 

99291: This Code is Used for Critical care, evaluation, and management of the critically ill or critically injured patient; first 30-74 minutes. It is to be reported only once per day per physician or group member of the same specialty.

99292: Critical care, evaluation, and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service). This code is used ONLY in conjunction with the 99291 code.  EACH additional thirty minutes beyond the first hour of critical care is reported using this code.  For example, if you spend 90 minutes on critical care in one calendar date, the encounter would be reported by using the 99291 for the first hour, plus one 99292 code used to report the additional 30 minutes.

Critica care settings :

Large medical facilities usually have intensive care units (ICU), where critical patients receive care. Some facilities have multiple units depending on the circumstances and needs of the community. ICUs might be located near the operating rooms for critical postoperative patients, or near the telemetry floor for patients who have life-threatening cardiac issues (e.g., cardiac care units).

Services included in critical care codes :

The following services are included in critical care codes, so coders should not report them separately:

§  The interpretation of cardiac output measurements

§  The interpretation of chest x-rays

§  Noninvasive ear or pulse oximetry for oxygen saturation 

§  Analysis of clinical data, stored in computers (e.g., electrocardiograms, blood pressures, hematologic data)

§  Gastric intubations, requiring a physician’s skill as well as fluoroscopy, image documentation and report

§  Temporary transcutaneous pacing (i.e., a temporary method of keeping the patient's heart beating by delivering small jolts of electricity to the heart)

§  Ventilatory management for patients who have been placed on ventilators to assist with breathing

§  Vascular access procedures for the purpose of drawing blood samples

 Time-based codes: 

Report critical care based on the time spent providing care. There are two codes used for critical care:

§  CPT code 99291: Critical care, evaluation, and management of the critically ill or critically injured patient; first 30–74 minutes.

§  CPT code +99292: Critical care, evaluation, and management of the critically ill or critically injured patient; each additional 30 minutes. (List separately in addition to primary service.)

Report code +99292 more than one time if the physician spends more than 30 

additional minutes. For example, consider the following:

§  For 75–104 minutes: Use 99291 X 1 and 99292 X 1

§  For 105–134 minutes: Use 99291 X 1 and 99292 X 2

§  For 135–164 minutes: Use 99291 X 1 and 99292 X 3

§  For 165–194 minutes: Use 99291 X 1 and 99292 X 4

The critical care codes coders assign should reflect the total time spent for each 24-hour period the physician provided critical care. The time does not have to be continuous.Get More Info at; Medical Coding Training Hyderabad

What is Emergency Department Coding?

Emergency Department:

An Emergency Department (E/D) is also known as an accident & emergency department (A&E), emergency room (ER), emergency ward(EW) or casualty department. The emergency department assesses and treats people with serious injuries and those in need of emergency treatment.

Emergency Medicine Coding:

Emergency Medicine displays an exceptional arrangement of difficulties for coding. This quick-paced high-volume claim to fame incorporates components of essential care E&M benefits up to injury administrations.

Four Basic Models:

•  Guidelines in light of the number or sort of staff intercessions. Both the AHA/AHIMA Guidelines and the ACEP Guidelines fall into this classification. Intercession models utilize fundamental care mediations to report the most minimal level of administration, with more elevated amounts appointed as intricacy or number of nursing and auxiliary staff intercessions increments.Get More Info on : Medical Coding online Training

• Guidelines in light of time went through with the patient. As time went through with the patient expands, so does the level doled out.

• Guidelines in light of a point framework. The time, intricacy, and kind of staff required deciding the quantity of focuses relegated to every mediation.

•Guidelines in light of patient seriousness. The analyses, level of medicinal basic leadership, and exhibiting grumbling or restorative issue are utilized to connect asset utilization.

Emergency Medicine Coding Background:

•  Directed by a broadly perceived crisis pharmaceutical coding and repayment master who is both an affirmed coder and a crisis room enrolled nurture.

•  Decades of experience coding for and preparing crisis solution doctors to enhance documentation and coding consistency.

•  Member of the American College of Emergency Physicians Subcommittee on Coding and Nomenclature.

• Expert witness for the Federal government on crisis solution coding extortion and manhandle.

•  Trained a great many crisis doctors how to enhance documentation and several coders how to code crisis pharmaceutical.

•          An expert on wandering installment arrangement framework and office coding in the crisis division.

Emergency Medicine Coding Need:

•  Well, prepared crisis prescription coders for both expert and office charges in the crisis office are elusive, costly to enlist, hard to keep, and their "care-and-nourishing" is expensive.

•   Few crisis medication coders are guaranteed, an image of vocation duty and quality coding.

•   Coding rules for the office and expert administrations are unpredictable, change frequently and are distinctive for the two sections.

•  Coder turnover and unlucky deficiencies make income crests and valleys.

• With so couple of coders gaining practical experience in this specialty, it is hard to discover and employ experienced crisis prescription coders, even in huge metropolitan regions. EDs in little groups and tight work markets experience difficulty filling openings and frequently should offer pricy sign-on rewards or different motivating forces that can possibly make contact with the current staff.

•  Facility coding rules have no national standard. Those rules made by singular healing centers regularly underestimate administrations.

Emergency Medicine Coding Solution:

•  TCN's crisis pharmaceutical coding administrations address both office and expert charges.

•  Your proficient or potentially office crisis solution coding will be finished inside 2-to-3 workdays if sent every day.

•  Send us cases by FedEx/UPS or electronically, or we can remotely get to your electronic therapeutic record.

•   At no extra charge, we will recognize any of your specialists' documentation insufficiencies to enhance the nature of your restorative records and streamline repayment.

•   All coding is done in the US of A by affirmed coders with at least 3 years crisis medication coding knowledge, who have finished our capability tests and keep up a 95% precision.

•  Our volume-driven per-visit estimating model is reasonable and our group of coders balances out income execution. You pay just for what you require, and never need to stress over wiped out leave, excursions, or family take off.

•    A down to earth answer for your crisis medication coding needs to enhance coding and documentation.

•  TCN prescribes ACEP Facility Coding Protocols to enhance office coding consistency and increment income.Learn More at Free Medical Coding Training

Emergency Medicine Coding Services 

•          Ongoing crisis drug coding administrations.

•          Temporary crisis drug coding administrations for get-away or debilitated leave scope.

•          Backlog coding determination administrations.

•          Compliance audits.

•          Hospital nursing staff documentation preparing.

•          Physician documentation preparing.

•          Nursing staff documentation preparing.

•          Hospital coding conventions.

•          Physician assembles documentation lack detailing.

•          Emergency pharmaceutical coding "helpline" administrations.