Faculty and Staff: For Your Benefit

Medical Compliance Services - March Tips of the Month

Physician Billing Compliance Tip

Cardiology

Is code 92973 the appropriate code for aspiration of a thrombus within a coronary vessel?

In the coronary system, “mechanical thrombectomy,” such as is described by 92973, does not include aspiration thrombectomy, and a parenthetical note in the CPT book under 92973 specifically excludes aspiration thrombectomy.

Aspiration thrombectomy is specifically included in 92941 and is actually also included in other interventions. In the rare case of aspiration thrombectomy being the only intervention, unlisted code 93799 could be billed.

Hospital Billing Compliance Tip

Documentation of Intravenous Infusion Orders & Administration of Drugs

A physician order is the result of an assessment documented in the physician’s note. The order should be signed, dated and describe the drug, dosage, administration route and rate/frequency for the drug to be given. When the drug is administered the nursing documentation should include the location of the injection/IV site, the vital signs when the infusion begins, the start time, the rate of the infusion, any monitoring interactions and the stop time.

Admission Order Requirement for Inpatient Hospital Stays

The Medicare law requires admission order completed by a physician with admitting privileges and knowledge of the patient’s condition(s). Payment for inpatient hospital services is dependent on the presence of admission order.

42 C.F.R 482.12© (2)

“Patients are admitted to the hospital as inpatients only on the recommendation of a physician or licensed practitioner permitted by the state to admit patients to a hospital.”

Research Billing Compliance Tip

Proper Claims for Clinical Trials

Avoid submitting improper claims related to clinical research by:

1. Pre-determining who is responsible for payment for item/service by performing a coverage analysis.

2. Identifying patients as research participants when scheduling research-related inpatient admissions, outpatient clinic visits, and office visits for treatment or evaluations.

3. Reviewing all study-related charge posting and claims to ensure services are billed to the proper payor.

4. Assuring the service has not been billed to or paid by both the study account and an insurance account.

More Billing Compliance Tips can be found at www.obc.med.miami.edu