CQW Panacea-re-brand-rev3

Respiratory

For the Week of August 25, 2014

Question:

I think your response to the NCCI encounter question may be incorrect. NCCI recently offered clarification regarding the term “encounter” in which it defines it as a period of time spent with the patient when providing a treatment, which is not the same as how CMS defines it as a length of stay.

Answer:

The Medicare Claims Processing Manual (Chapter 2, section 90.6) gives the following definition of encounter. (This chapter can be found at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c02.pdf.)

"The term 'encounter' means a direct personal contact in the hospital between a patient and a physician, or other person who is authorized by State law and, if applicable, by hospital staff bylaws to order or furnish services for diagnosis or treatment of the patient. ... When a patient has follow-up visits with a physician in the hospital following an initial encounter, each subsequent visit to the physician will be treated as a separate encounter for billing."

According to a May 20, 2014 news item from the American Association for Respiratory Care (AARC), "...it would appear hospitals should consider each visit by a respiratory therapist to be an encounter, especially in light of the advice from CMS that subsequent inhalation treatments with separate patient encounters on the same day can be reported with a modifier. ... in some cases, hospitals are considering the individual treatment sessions as the 'entire visit,' when in fact the definition itself would indicate otherwise." (For the AARC's article entitled "Update on NCCI Edits Regarding Inhalation Treatments," go to https://www.aarc.org/headlines/14/05/ncci.cfm​.)

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