Part B Insider - 2018 Issue 8
Compliance: Be Careful When You Code Concurrent Care
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Article Overview
This article reviews how concurrent care is distinguished from duplicative care, with emphasis on documentation, diagnosis coding, and claim presentation when multiple physicians are involved in treating the same patient. It is aimed at coders, compliance staff, and physician practice personnel who need to understand the general reporting considerations for these claims and the type of supporting notes that help substantiate them.
Why This Topic Matters
Concurrent care claims can be scrutinized if the services appear overlapping or insufficiently documented. Understanding the broad compliance and coding issues helps reduce denials and supports accurate claim submission.
Article Sections
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Ensure the Care Is 'Concurrent,' not 'Duplicative'
Introduces the distinction between concurrent and duplicative care and discusses the general criteria used to evaluate whether multiple physicians are involved appropriately.
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When a Patient Has Multiple Issues, Focus on Diagnosis Codes
Covers a scenario involving more than one physician, multiple conditions, and separate E/M services, with attention to how diagnosis reporting relates to the encounter.
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Remember, Concurrent Can Feature Only 1 Diagnosis
Discusses the possibility that multiple physicians may report the same diagnosis in concurrent care situations and the broader reporting implications.
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Bolster Concurrent Claims with Solid Notes
Explains the importance of clear clinical documentation when supporting concurrent care claims and responding to payer review.
What You Will Learn
- How concurrent care is differentiated from duplicative care at a high level
- Why diagnosis reporting matters when more than one physician treats the same patient
- What kinds of documentation support are emphasized for concurrent care claims
- How multiple physicians and specialties can be involved in the same patient’s care
Who Should Read This
- Medical coders
- Compliance officers
- Physician billing staff
- Practice administrators
- Clinical documentation staff
Codes Discussed
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