General Compliance Question of the Week

General Question for the Week of July 12, 2021

Question:

Regarding the Appropriate Use Criteria (AUC) program, CMS recently stated “Currently, the program is set to be fully implemented on January 1, 2022, which means AUC consultations with qualified CDSMs are required to occur along with reporting of consultation information on the furnishing professional and furnishing facility claim for the advanced diagnostic imaging service. Claims that fail to append this information will not be paid.” Our hospital images are read by an outsourced radiology group. Will the hospital still receive payment for the technical portion if AUC requirements are not met? Will the radiologist’s claim be completely denied?

General Compliance Question of the Week

General Question for the Week of June 28, 2021

Question:

I have a question regarding the obstetrical (OB) ultrasound documentation guidelines. I know that the uterus and adnexa are required elements, but some of the providers feel that documenting an IUP should be sufficient for the 1st trimester (76801/76802). For codes 76805/76810, the guidelines state maternal adnexa should be reported “when visible.” So, do the doctors not have to document it when it is not visible?

General Compliance Question of the Week

General Question for the Week of June 21, 2021

Question:

What is your opinion on how to use diagnosis Z18.10 – Retained foreign body fragments, metal – for a new gunshot wound (GSW)? I think of ‘retained’ as being old and embedded, but there are differing opinions in my department. If the patient has a new GSW to the tibia and fibula with fractures and for a chest and abdomen x-ray taken around the same time as the tibia & fibula, they state in the impression, “small metallic fragments project over the left middle to upper lung zone and left lateral abdominal wall, likely from a gunshot wound”, would you use Wound, unspecified to the abdomen and chest walls or retained foreign body fragments, metal? Or neither?