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Advanced Coding and Advanced Coding and Advanced Coding and Advanced Coding and DocumentationDocumentationDocumentationDocumentation
for RHCsfor RHCsfor RHCsfor RHCs
By: Joanie Perkins, CPC
� What services qualify as an encounter
� Documenting Diabetic Ed and Mental Health Services
�How to Bill and Document hospital services
� How to document Medicare and Medicaid preventive services in the RHC
�For Diabetic Education
�Mental Health Services (rev code 090X)
� And Chronic Care Management Services (CCM)
�
� E/M code 99211 is commonly
used for nursing visits, (injection
administration, etc.), even though
physicians sometimes bill them.
�For Medicare and Medicaid RHC
purposes, these are not considered
encounters
� They are often reimbursed for
commercial payers, so use them
when appropriate.
Examples:
a. Monthly B12 injection for pernicious anemia
b. Dressing change
Return to work/school
Not Medicare/Medicaid pts.
Physician services at the hospital and
other off-RHC campus locations are
billed to WPS Medicare Part B for fee-
for-service reimbursement and are
carved out of the RHC cost report.
If the parent-entity of the provider
based RHC is a Critical Access
Hospital (CAH) using option II billing-
out-patient hospital services are
billed to the parent hospital’s MAC.
� Not all Hospital Admissions are 99223
o Requires Medical Decision Making of High Complexity
� Not all Hospital Discharges are 99239
o Discharges are time driven codes…document the amount of time on
the discharge note
� Utilize the 3 levels of care for subsequent care, don’t get
stuck in a rut
o Common errors are coding the lowest levels of care for subsequent
days
o Hospital daily coding should tell a story about the patient’s
condition
� These are incident to the physician or
mid-level services. Bundle them into the
charge.
� The costs for these services are
included in the cost report.
� When utilizing educators in the RHC – Plan ahead
� This includes Certified RN’s for foot care
o Discuss where in the chart you want the note
o Discuss what medically reasonable services will be performed by
the RHC provider on the day of the education encounter
o Review Medicare’s payment limitations for a specific service and
abide by them
� Mental Health Services performed
by a qualified provider (LCSW,
Psychiatrist, Clinical Psychologist)
are billable
� Psychotherapy notes are subject to additional security and
may not be available to all RHC providers
� HIPAA’s description:
o notes recorded (in any medium) by a healthcare provider who is a
mental health professional documenting or analyzing the contents
of conversation during a private counseling session or a group,
joint, or family counseling session, and that are separated from the
rest of the individual’s medical record.
� Indiana Law is more strict than HIPAA – find it here:
http://www.in.gov/legislative/bills/2011/PDF/IN/IN1493.1.pdf
�Once in a lifetime benefit
�Effective 1/1/09 RHC’s may bill for the
professional portion of the IPPE in
addition to a daily encounter (G0402)
Co-pays and deductibles are waived
�CMS states “in rare circumstances,
depending on the clinical appropriateness of
a separate visit, to allow RHC’s to receive
separate payment for an encounter, in
addition to the payment for IPPE when they
are performed on the same day”
� Consent should only be obtained once
� Must have documented informed consent including the
following:
o CCM services written agreement authorizing electronic
communication of medical information with other treating providers
o Information that only 1 provider/month can furnish the service
o How to revoke the service
� Should include a discussion with the patient and/or
caregiver about:
o What CCM Service is;
o How to access the elements of the Service;
o How the patient’s information will be shared;
o How Co-pay’s and Deductibles are applied
o How to Revoke the Service
Be sure and document the discussion in the medical record
� Must record structured patient health information data to
include:
o Patient Demographics
o Problem List
o Medications
o Allergies
o Create structured clinical summary records using certified EHR
technology
� Medical, Social and Family History
� Review of Risk Factors
� Review of Functional Ability
� Exam
� End of Life Planning
� Educate, Counsel, and Refer based on the Previous Five
Components
� Educate, Counsel, and Referral for Other Preventive
Services in the Form of a Brief Written Plan
At a minimum, collect information about….
�Past medical/surgical history
�Current medications and supplements
�Family history
�History of alcohol, tobacco, and illicit drug use;
�Diet; and
�Physical activities
�Staff Reviews the patient’s potential risk factors
for depression and other mood disorders by
using a Depression Scale for patients without a
current diagnosis of depression or other mood
disorders
� This is the PHQ-9
�http://www.phqscreeners.com/sites/g/files/g1
0016261/f/201412/PHQ-9_English.pdf
At a minimum, collect information about….
�Hearing impairment;
�Activities of daily living;
�Fall risk; and
�Home safety
� The plan must be patient-centered and based on a physical,
mental, cognitive, psychosocial, functional and
environmental assessment and inventory of resources
� Must provide the patient with a copy of the plan either on
paper or electronically and document you gave it to them in
the medical record
� Problem list
� Expected Outcome/Prognosis
� Measurable Treatment Goals
� Symptom Management
� Planned interventions and identify responsible individuals
� Medication Management
� Social Services ordered and how the practice will
coordinate them
� Schedule for periodic review/revision
� Patients must have 24/7 access to care management
services with means to make timely contact with providers
who have access to the patients electronic care plan
� Ensure continuity of care with a designated provider (pt is
able to get routine appointments)
� Provide enhanced communication for patient and
caregivers to the provider
