| |
Please review our anesthesiology coding compliance example and let us know if you have any questions. |
| Physician |
Patient |
Original
RBRVS Units |
TCN's
RBRVS Units |
Difference |
% |
Unbundled |
Missed
Procedure |
Billed
but Not Done |
Wrong
Code |
Modifier |
Supplies
& Meds |
Order |
Documentation
Deficiency |
Diagnosis |
| White |
1 |
19.95 |
41.64 |
-21.69 |
-108.7 |
X |
XXXXX |
|
|
|
XXXX |
|
|
X |
| White |
2 |
33.11 |
18.41 |
14.7 |
44.4 |
|
|
XXX |
|
|
X |
|
X |
XX |
| McGann |
3 |
13.53 |
18.53 |
-5.0 |
-37.0 |
|
X |
|
XXX |
|
XXX |
|
|
X |
| Garvey |
4 |
22.64 |
20.37 |
2.27 |
10.0 |
X |
|
XX |
X |
|
X |
|
|
|
| Garvey |
5 |
32.23 |
33.34 |
-1.11 |
-3.4 |
XX |
X |
XX |
X |
|
9 |
X |
|
X |
| Holt |
6 |
2.18 |
2.12 |
.06 |
2.8 |
|
|
X |
|
|
XXX |
X |
X |
X |
| Arkin |
7 |
9.37 |
9.25 |
.12 |
1.3 |
|
|
X |
|
|
|
|
|
|
| Murry |
8 |
38.00 |
31.72 |
6.28 |
16.5 |
X |
X |
XXXXXX |
|
|
X |
X |
|
X |
| Murry |
9 |
12.69 |
12.21 |
.48 |
3.8 |
|
|
X |
|
|
|
X |
|
XX |
| Jones |
10 |
29.48 |
43.86 |
-14.38 |
-48.8 |
|
|
X |
XXXXXXXX |
|
|
|
|
X |
| Positive
percentage difference means original coding overvalued the case. |
|
| Patient:
1 |
DOS:
01/15/03 |
Doctor:
White |
Original
Codes
62291
72285-26
76005
99141
A4550
A4208
J2175
J2550
A4209
J2000
A4644
A4212 x 7
J2250 x 5
J3010 |
RVU's
9.32
1.61
2.10
2.96
1.06
0.01
0.04
0.08
0.01
0.13
0.00
2.10
0.45
0.08 |
Total
RVU's 19.95
|
|
The
Coding
Network's Codes
62291
x 3
72285-26 x 3
99213-25
99141
A4550-Surgical Tray
A4208-3cc Needle
J2175-Demerol
J2550-Phenergan
A4209-5cc Needle
J2000-Lidocaine
A4644-Contrast
A4212-Stylet x 7
J2250-Versed x 5
J3010-Fentanyl
J1642-Heparin Lock Flush
J0690-Ancef
A4246-Betadine
J1885-Toradol |
RVU's
27.96
4.83
1.39
2.96
1.06
0.01
0.04
0.08
0.01
0.13
0.00
2.10
0.45
0.08
0.02
0.11
0.11
0.30 |
Total RVU's 41.64 |
|
Discussion:
- 3 levels
were injected for discography, not 1, therefore, 62291 &
72285 should be quantity 3.
- Procedure
76005 is inclusive with procedures 62291 & 72285.
- Per
documentation, Level 3 Established Patient Visit can be
billed.
- Additional
drugs & supplies were missed.
|
| Diagnoses:
722.51
Thoracic Disc Degeneration |
Diagnoses:
722.51
Thoracic Disc Degeneration
722.11 Thoracic Disc Displacement |
Discussion:
- Post-Op
diagnosis should be appended.
|
|
| Patient:
2 |
DOS:
11/21/02 |
Doctor:
White |
Original
Codes
64470
64472 x 5
94760
J3302 x 8
J1885
J2000
A4209 |
RVU's
5.99
26.40
0.12
0.16
0.30
0.13
0.01 |
Total
RVU's 33.11
|
|
The
Coding
Network's Codes
64470
64472 x 2
94760
J3301-Kenalog x 8
J1885-Toradol
J2000-Lidocaine
A4209-Needle
A4550-Surgical Tray |
RVU's
5.99
10.56
0.12
0.24
0.30
0.13
0.01
1.06 |
Total RVU's 18.41 |
|
Discussion:
- Only
3 levels were injected, therefore, 64470 should be quantity
1 and 64472 should be quantity 2, not 5.
- Kenalog
is Triamcinolone Acetonide (J3301) not Triamcinolone Diacetate
(J3302).
- Billing
for Surgical Tray was missed.
|
| Diagnoses:
721.0
Cervical Spondylosis
722.4 Cervical Disc Degeneration
723.1 Cervicalgia |
Diagnoses:
723.1
Cervicalgia
346.90 Migraine, unspecified
719.45 Hip Pain |
Discussion:
- Diagnoses
721.0 & 722.4 are not supported by the documentation
provided.
|
|
| Patient:
3 |
DOS:
12/02/02 |
Doctor:
McGann |
Original
Codes
64450
64450-51
64450-51
64450-51
94760
A4209
A4215
J2000
J1885 x 2
J1030 |
RVU's
3.14
3.14
3.14
3.14
0.12
0.02
0.00
0.13
0.60
0.10 |
Total
RVU's 13.53
|
|
The
Coding
Network's Codes
64475
64476 x 2
99213-25
94760
A4209-Needle x 2
A4550-Surgical Tray
J2000-Lidocaine
J1885-Toradol x 2
J1020-Depo-Medrol |
RVU's
5.32
9.80
1.39
0.12
0.02
1.06
0.13
0.60
0.09 |
Total RVU's 18.53 |
|
Discussion:
- Per
documentation, lumbar paravertebral nerve blocks were performed
at 3 levels. Correct codes are 64475 & 64476, not 64450.
- Per
documentation, Level 3 Established Patient Visit can be
billed.
- Correct
code for Depo-Medrol 20 mg is J1020 not J1030.
- Billing
for Surgical Tray was missed.
|
| Diagnoses:
724.4
Lumbar Radiculitis |
Diagnoses:
724.4
Lumbar Radiculitis
724.02 Lumbar Stenosis
716.98 Facet Arthropathy, Lumbar |
Discussion:
- Supporting
diagnoses should also be coded.
|
|
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