tci Part B Insider - 2003 Issue 7

COVERAGE: Dx Should Be Reason for Extra Nursing Home Visits

If a physician visits a nursing home patient more frequently than Medicare will usually cover, it's up to the physician to explain in the electronic record what happened, according to Cahaba GBA's draft policy. "When it is medically necessary to visit a nursing home patient at a frequency greater than usual, list as the primary diagnosis on the claim the symptom or sign that made it necessary for the physician to see the patient," Cahaba instructs physicians. That way, you won't have to submit medical-necessity documentation later. Cahaba gives the example of an 80-year-old nursing home patient with...

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