for nurse practitioners医生护士的帐单课件

Billing for Non- Physician Practitioners Presented by NYU School of Medicine Office of Physician Reimbursement Compliance Gretchen L. Segado, MS, CPC, Director 316 East 30th Street New York, NY 10016 (212) 263-2446 (212) 263-6445 fax Gretchen.S Goals for This Session Understand the difference between Direct Billing and Incident-to Billing Understand need to learn CPT and ICD-9 coding principles i.e. Understand E for biopsy 25105for synovectomy Reads: 25105Arthrotomy, wrist joint; for synovectomy Linkage Between ICD-9 & CPT (Continued) ICD-9 represents the “WHY” component of the procedure CPT-4 represents the “WHAT” component of the procedure How Does It Differ From ICD-9? ICD-9 represents to the carrier why a service was billed: Medical Necessity- 786.50 (Chest Pain) CPT-4 represents to the carrier what was billed: Procedure- 93010 (EKG) Over 17 different Otitis Media Codes Acute? Chronic? Supportive? Serous? Mucoid? Over 28 different codes for Diabetes Type I or II? Insulin Dependent? With complications? Acute Upper Respiratory Tract Infections 4 codes Disorders of Lipid Metabolism 11 codes Establishing The Medical Necessity For Procedures Only clinically proven effective procedures are reimbursable under the Medicare program Medicare has a specific list of ICD -9 codes that support the medical necessity of each procedure Medical Necessity Diagnostic studies ICD-9-CM without established diagnosis (i.e., rule out, probable, suspected) Example: Pelvic Ultrasound for R/O Ectopic Pregnancy Report signs & symptoms Pelvic Pain (625.9) Medical Necessity (continued) Diagnostic studies with confirmed or established diagnosis Report the ICD-9 Code representing the confirmed diagnosis Example: Diagnostic Study:ICD-9 Linkage Pt. for Pelvic Ultrasounduterine fibroid (218.9) Documentation Of Technical Detail Of Procedure 1. Pre-operative evaluation 2. Medical Necessity 3. Separate note for the procedure 4. Complete procedure note itself 5. Signed and Dated by the MD Procedure Note Anesthetized with 2% Lido + Epi irrigated with NS, and Explored Laceration was subcutaneous, approx 6 cm w/ skin flap Wound closed with #8 sutures (4-0 nylon interrupted sutures) Signature Evaluation And Management Services Codes 99201 to 99499 Basic format: Unique code number is listed Place/type of service is specified Content of service is defined Nature of presenting problem usually associated with a given level is described Time typically required to provide the service is specified Categories Of E/M Services Office or other Outpatient Services New and Established Patients Hospital Observation Services Initial Hospital Care Subsequent Hospital Care Hospital Inpatient Services Initial Hospital Care Subsequent Hospital Care Categories Of E/M Services (Continued) Consultations Office of Other Outpatient Consultation Initial Inpatient Consultation Follow-up inpatient Consultations Confirmatory Consultations Emergency Department Services Critical Care Services Categories Of E/M Services (Continued) Neonatal Intensive Care Nursing Facility Services Preventive Medicine Newborn Care Special Evaluation and Management Services Other Evaluation and Management Services Is This A New Patient Visit Or An Established Patient Visit? New Patient Has not received any professional services from the physician or another physician of the same specialty, same group practice, within the past three years Established Patient Has received professional services from the physician or another physician of the same specialty, same group practice, within the past three years Is This A Problem Oriented Visit Or A “Well Visit”? Preventive Medicine Services are a special category of E&M Code selection is based on patients age and status with the practice 99381-99387 Initial Comprehensive Preventive Medicine 99391-99397 Periodic Comprehensive Preventive Medicine Keep Your Practice Safe Learn how to