In the outpatient setting, do not code a diagnosis unless it is certain. Examples of language seen in the medical record that identify uncertain diagnoses include: Probable Suspected Questionable Rule out Differential Working When a definitive diagnosis has not been determined, code the signs, symptoms, and abnormal test result(s) or other reasons for the visit. […] AAPC Knowledge Center
The Medicare Payment Advisory Commission’s (MedPAC) June Report to the Congress addresses (among other things) issues it sees with the Merit-based Incentive Payment System (MIPS) — one of two paths in the Centers for Medicare & Medicaid Services’ (CMS) Quality Payment Program, and a provision of the Medicare Access and CHIP Reauthorization Act (MACRA). “As […] AAPC Knowledge Center
If my physician says in his documentation that he personally reviewed the IMAGES of the patients mri scan and also reviewed the report from the radiologist, can he get three points in the data section of medical decision making? So, in other words, he did not just read the radiologist report but actually looked at the scan himself. It states, "independent visualization of image, tracing or specimen itself (not simply review of report), which he did an independent visualization. Does he have to give his own interpretation to get the two points and if so, does it have to be a "formal" report? Can he also get the one data point for review and/or order of tests in the radiology section of CPT as well since he states that he reviewed the report? I wasn’t sure if getting three points would be considered "double dipping". Any comments would be appreciated!
A new Program for Evaluating Payment Patterns Electronic Report (PEPPER) for Home Health Agencies (HHAs) is available through the PEPPER Resources Portal. CMS contracts with TMF to produce and distribute these free reports that summarize HHA claims data statistics for areas that may be at risk for improper Medicare payments. HHAs can use the data to support internal auditing and monitoring activities. Compare your Medicare billing practices with other HHAs in the nation, Medicare Administrative Contractor jurisdiction, and state.