Compliance Question of the Week – General

If a record only states “lupus” what would this condition map/code to? I am an auditor at work, and I am in a debate on how to code lupus not otherwise specified (NOS). I say this condition codes to L93.0 but a colleague suggests I am incorrect and that lupus should code/map to M32.9? Do you have any guidance on this particular condition?

How should we bill Medicare for cochlear devices replaced without cost to the hospital or beneficiary?

Where can we find the evaluation and management documentation guidelines?

How do I request a change in the MUE value for a CPT® code?

What is the difference between medical necessity and medical decision-making?

Do CPT® codes for psychological and neuropsychological tests include tests performed by technicians and computers?

I’d like to find out more about the new Medicare diabetes-prevention program. Can you supply a source?

What are the Medicare rules for a situation when two or more diagnoses equally meet the definition for principal diagnosis? For example, we had a patient who was admitted with systolic congestive heart failure exacerbation and aspiration pneumonia. Both are equally worked up (IV antibiotics, speech eval, NPO, IV Lasix, new echo, etc.).

How should we bill Medicare for active cardiopulmonary resuscitation (CPR) given to a patient who arrives at the emergency department (ED) and has a cardiac arrest on arrival? For example, should we bill critical care services or code 92950?

Can you explain the Medicare policy related to the term “mutually exclusive”?

If I receive a bundling message that says something is included in a service billed on the same day and I do not find evidence of this edit in the latest version update of the National Correct Coding Initiative (NCCI), who should I ask about this denial?

In the inpatient and outpatient charge data, what is the difference between “average charges” and “average total payments”?