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Great insight, Shannon! Also, I love your paw necklace 🐾❤

Thank you Shannon for this!❤

I code for cardiology and and they frequently manage patients in the hospital with inotropes and vasodilators. These patients are in cardiogenic shock. It would seem the risk of morbidity or mortality would warrant HIGH RISK. As if they weren’t making those decisions the patient would most likely die? Would this be true?

Great points as always! I love that you highlighted the clinical indications for surgery. When well documented, those indications could drive code selection, particularly if we need to know whether it is a chronic or an acute problem to select the correct CPT and ICD-10CM codes. (Think rotator cuff repairs.)

Great info from Shannon as always! BTW Love the new hair!!

Will NAMAS offer a surgery auditing course in the future? Thank you!

Patients have a “expectation” of an annual physical because of what they received their entire life! That’s because Medicare doesn’t pay for an annual physical! An annual wellness visit is NOT an annual physical! Patients should not have to request tests for each body part. Contact CMS and your representatives! They know how important a basic annual physical is to longevity. Why have seniors and their agents tolerated loss of this basic coverage?

Medicare doesn’t pay for an annual physical! An annual wellness visit is NOT an annual physical! Patients should not have to request tests for each body part. Contact CMS and your representatives! They know how important a basic annual physical is to longevity. Why have seniors and their agents tolerated loss of this basic coverage?

That’s because Medicare doesn’t pay for an annual physical! An annual wellness visit is NOT an annual physical! Patients should not have to request tests for each body part. Contact CMS and your representatives! They know how important a basic annual physical is to longevity. Why have seniors and their agents tolerated loss of this basic coverage?

The AWV is a complete worthless scam. Find a doctor that will give you a physical.

How does this apply to mobile phlebotomy services performed at a Sniff?

1. If we refer the pt to for home nurse visiting services to other facilities 2. we received a document that this Nurse gave these services to the pt at his/her home for this much period. which we can bill Is it Okay to use the 99211 code for Biling Purpose? kindly plz guide me more. Thank You

If your physicians says "No stemi" on EKGs do you think this is sufficient to meet independent interpretation as part of the MDM. Or for Xrays using a template states "interprered by me, negative"

Another great tool provided by NAMAS! Thanks Shannon

There is no vs. physicals. Medicare does not allow physicals. Period.

Does a modifier 26 need to be added to the xray or does tge snf pay for the global

Thanks so much Shannon! We are having an internal issue with coding a problem-oriented visit at the time of a preventive service. There is conflicting info out there as we have seen guidance that states, ordering labs and refilling prescriptions during a preventive visit is included in that preventive service. However, as you state in your video, if the provider is "managing" those chronic conditions and they have the supporting documentation, then the additional visit is billable. Do you know of any guidance that specifically states that refilling prescriptions and ordering labs are included in the preventive service? Either way, thanks Shannon for your efforts keeping us auditors/coders compliant :) I appreciate all that you do for our industry, you are a true leader!

Right. The "wellness" visit is total BS that does nothing for the patient, period. Just gives the provider money for nothing. They ask you if you have problems x,y,z and when you say yes you do, that's the end of it, nothing done about any problems. Go back and do that again every year, same problems "yes", nothing done, no followup. No point whatsoever.

I always look forward to your videos. They're both educational and entertaining!

Thank you Shannon is there any education for sale with examples

Excellent explanation

I've a general question about prescription management. Would you count 'Continue medication and follow-up per PCP' as prescription management? Would you count this statement as prescription management if you list the medication? Thank you.

Absurd. Total BS.

Hi Shannon, I have an important question that I probably need to email you directly.. is this possible, and if so, how can I reach you?

Thank you Shannon, this is what I have been trying to say to fellow auditors in my group as well. The full title of that column says...The risk of AND/OR I agree with you also, documentation is key, because if extensive evaluation may be required to reach the conclusion that the signs or symptoms or multiple conditions in aggregate may represent a highly morbid condition (due to interaction) it should be clearly captured in documentation and considered under column 3 (Risk). Also, if you do a search of the definitions, risk of morbidity is described for almost every problem defined (i.e., under Stable, chronic illness: A patient who is not at his or her treatment goal is not stable, even if the condition has not changed and there is no short-term threat to life or function...the risk of morbidity without treatment is significant). This is described in almost every definition. Yes, risk of condition is distinct from risk of complication/management but the guidelines make clear that these often times correlate.~

Hi Shannon! I have heard that UHC and Cigna are both going to deny any E&M with 25 modifier/procedures and requesting notes - have you heard this? Thanks for all you do and all the great information!

NAMAS MEDICAL, Most of my providers don't have any Addendum FORMS or will except Addendums from a client or member, isn't this against the laws or file a complaint with the medical board? for the providers writing incomplete and omission leaving out information.

Shouldn't the provider state minimal low, moderate,or high risk for that particular patient?

Why doesn't anybody talk about the document changes for SNF and what should be in the documentation?

Do you factor in differential diagnosis on the profee side?

This is helpful, but wouldn't the review of all of that provider's notes and tests count for 1 point based on the definition "review of all materials from 1 source count for 1 point"? I have more questions on this in the hospital setting- if a specialist is seeing an admitted patient for the 1st time, and reviewing 3+ tests ordered by the hospitalist or ER MD, would that count for 3 points or 1 point based on that portion of the definition, all materials from one unique source?

Very nice explanation of the concept. Thank you

Would this apply to 800 mg of OTC Ibuprofen?

I love this Shannon; definitely spot on!!! Thank you as always.

Great points, good job breaking down coding policy vs reimbursement policy and assumptions.

Is it possible to dive deeper into the risk of management, maybe some scenarios. I'm having a hard time understanding what should be represented in documentation. Thanks

Love the video's. You explain things in an easy to understand way. Please, keep them coming!

'promo sm' 👍

Yes yes yes!!!!!

I like your gnomes!

If the patient is positive for COVID, this is a moderate 4 because COVID is a systemic illness according to Medicare

Finally found your channel 🫶🏻

Sounds good!

Love your videos, they are very informative. I have been struggling a little with the 2021 E&M definition of Acute, Uncomplicated Illness or Injury vs Acute, Complicated Injury, specifically for orthopedic cases. Would you be able to create a video on that? Some examples would be a traumatic rotator cuff tear, meniscal tear, tibia fracture (one problem per patient), for which the provider recommends surgery as the patient continues to struggle with conservative treatment. Assuming the documentation does not indicate evaluation of other body systems not directly related to the injury. Would these individual examples be considered " Acute, uncomplicated Illness or Injury" or "Acute, Complicated Injury". Thank you!

Thank you so much!

Wow! Great break down on "Morbidity" Shannon. Love NAMAS!

Great take!

More resources for the 2021 E&M Documentation Guidelines and the 2023 AMA Revisions can be found at namas.co/2021-changes/