You have been the supervisor of coding for about 6 months at a local community hospital.

You have been the supervisor of coding for about 6 months at a local community hospital.  You have been familiarizing yourself with what has been happening in the areas of quality, quantity, work ethic and compliance with all coding regulations and requirements.  

Every week you receive a list of rejections that you need to review and provide recommendations to appeal if needed.  The priority are high volume and high $ amount rejections. You recognize that there is a problem with the quality of the coding related to:

1) Medical necessity;

2) Medicare reimbursement policy regarding assistant surgeon;

3) Reimbursement policy of commercial plan regarding age of patient;

4) Missing or incomplete documentation.  

Please see table – summary of rejection issue, findings and recommendations.  Identify the correct CPT procedure codes and ICD-10-CM diagnosis codes; determine the LCD policy of CPT 93880 and identify the list of diagnoses supporting medical necessity; use NCCI edits for multiple procedures and apply the correct modifiers to bypassed the edits; print the result of Physician Compliance Edit.