Billing Brilliance: How PM&R Physicians Can Navigate Inpatient Billing Changes with Ease (enduring)-Billing Brilliance: How PM&R Physicians Can Navigate Inpatient Billing Changes with Ease (enduring)

Video Transcription

Video Summary

In this video, Linda Duckworth discusses the evaluation management coding changes for 2023 in the inpatient rehabilitation and nursing facility settings. She emphasizes reading the full set of guidelines from the American Medical Association (AMA) for a more detailed understanding of the changes. <br /><br />Duckworth explains the three components of the decision-making process for evaluation management coding: problems addressed, data, and risk. She advises providers to document the severity, chronicity, and status of conditions to help coders and reviewers understand the decision-making process. She also discusses the changes in documentation requirements, such as eliminating unnecessary fluff in the medical record.<br /><br />Duckworth then explains the changes in the data component of the decision-making process, including the criteria for counting tests, discussions, and independent historians. She stresses the importance of documenting discussions and social determinants of health.<br /><br />She provides examples of low, moderate, and high-level visits to illustrate how different combinations of problems addressed, data, and risk can result in different code levels. She also highlights the importance of accurately documenting management decisions, especially regarding drug therapy and decisions regarding hospitalization or escalation of care.<br /><br />The transcript highlights the importance of proper documentation in prescription drug management, evaluating the appropriateness of medication, and clearly conveying actions taken. It also discusses Medicare guidelines for hospitalization or escalation of care, time-based billing, reviewing data from the rehab team, and coordinating care with them.<br /><br />Overall, accurate and detailed documentation is emphasized for proper coding and billing.

Keywords

Linda Duckworth

evaluation management coding

2023 changes

inpatient rehabilitation

nursing facility settings

decision-making process

documentation requirements

severity

chronicity

drug therapy

hospitalization