Clinic visit prior to Kypho?

[oneforfighting]

Patient with h/o of compression fxs comes in to clinic with acute on chronic back pain. Following day MRI shows acute thoracic compression fracture.

Question: Do I need to bring the patient back into clinic to review the MRI and order Kyphoplasty or can I just schedule and do an addendum to my most recent clinic note?
This patient has Medicare which does not require prior auth.
She has had prior Kypho with me this year and already indicated that she would want repeat procedure if new fracture.
I usually bring patients back in to office just so that I can go over the imaging and answer any questions they may have to head off any last minute surprises. However, this patient states she trusts me and my plan so not sure if it'd make sense to have her come in. Just not sure if there is anything I haven't thought of.
Thanks as always for your input.

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[lobelsteve]

No reason for OV. Just do kypho.
Did you start Prolia/Evenity/Tymlos.

Own the bone.

 

[oneforfighting]

No reason for OV. Just do kypho.
Did you start Prolia/Evenity/Tymlos.

Own the bone.

Sent her to endo but she didn’t want daily injections.

 

[painfree23]

I think u can see her for a clinic visit the same day u do the kypho (add modifier for the OV). Just make sure she’s not on anticoagulantion before coming in

 

[drusso]

Patient with h/o of compression fxs comes in to clinic with acute on chronic back pain. Following day MRI shows acute thoracic compression fracture.

Question: Do I need to bring the patient back into clinic to review the MRI and order Kyphoplasty or can I just schedule and do an addendum to my most recent clinic note?
This patient has Medicare which does not require prior auth.
She has had prior Kypho with me this year and already indicated that she would want repeat procedure if new fracture.
I usually bring patients back in to office just so that I can go over the imaging and answer any questions they may have to head off any last minute surprises. However, this patient states she trusts me and my plan so not sure if it'd make sense to have her come in. Just not sure if there is anything I haven't thought of.
Thanks as always for your input.

Don't give away your time. Counsel and offer medical advice about exercise, pros/cons of bracing, hazards of bed rest and immobility, calcium supplementation, diet and lifestyle factors, tobacco cessation, bone health, etc. You've earned every penny of your specialized knowledge and time.

 

[callmeanesthesia]

Just schedule if you already discussed kypho and she wants to proceed. Add a line in your procedure note that you reviewed and discussed imaging results with her.

 

[RoloTomassi]

I would do a quick tele visit. Faster and more convenient for someone with a fx. Can bill the same complexity. Covers you as a documented consent discussion. Splits the difference.

 

[Ducttape]

i would do a tele visit too.

but you dont need to bring her in since there are no insurance denials.

i would suggest that you do an appropriate physical exam prior to the kypho in your operative note.

 

[oneforfighting]

I think u can see her for a clinic visit the same day u do the kypho (add modifier for the OV). Just make sure she’s not on anticoagulantion before coming in

Does it matter if I’m doing kypho (and hence clinic visit) at the hospital and not the office? What modifier do you use?

 

[oneforfighting]

Don't give away your time. Counsel and offer medical advice about exercise, pros/cons of bracing, hazards of bed rest and immobility, calcium supplementation, diet and lifestyle factors, tobacco cessation, bone health, etc. You've earned every penny of your specialized knowledge and time.

This is a good point. I think this needs to be documented any way for insurance purposes.

 

[Ronin1]

Documentation is good. I was audited regarding RFA this year and it was nice having those visit notes documenting responses to MBB and the plans for RFA.

 

[oneforfighting]

Planning on a televisit this AM. Thanks all!

 

[Ducttape]

Does it matter if I’m doing kypho (and hence clinic visit) at the hospital and not the office? What modifier do you use?

you technically cannot bill for the visit if you are only doing a kypho. from what i have been told, all of that discussion is part of the procedure if you are doing it on the day of the procedure.


now, if you talk about osteoporosis and discuss a bisphosphonate for osteoporosis, that you can bill separately for, as it is a separate diagnosis.

or give a referral to PT for gait imbalance.

 

[lobelsteve]

you technically cannot bill for the visit if you are only doing a kypho. from what i have been told, all of that discussion is part of the procedure if you are doing it on the day of the procedure.


now, if you talk about osteoporosis and discuss a bisphosphonate for osteoporosis, that you can bill separately for, as it is a separate diagnosis.

or give a referral to PT for gait imbalance.

But then why use bisphos after Fx? Why discuss if you don’t manage?

If you just want to do the kypho, then dictate a note saying what you found that you discussed it with the patient and that you’ll proceed. You can meet insurance criteria without wasting the patient’s co-pay. If you want to manage their osteoporosis, bring them in do the bloodwork, provide counseling and get started. I don’t do kyphoplasty anymore unless I’ve already got them, started on some thing to prevent the next fracture.

Merry Christmas and here is my office tree topper just welded up.

 

[Ducttape]

But then why use bisphos after Fx? Why discuss if you don’t manage?

If you just want to do the kypho, then dictate a note saying what you found that you discussed it with the patient and that you’ll proceed. You can meet insurance criteria without wasting the patient’s co-pay. If you want to manage their osteoporosis, bring them in do the bloodwork, provide counseling and get started. I don’t do kyphoplasty anymore unless I’ve already got them, started on some thing to prevent the next fracture.

because it is in the patient's best interest?

giving patients education on what is best for their health is part of what we do, and you practice that all the time, even if you dont prescribe. education is as important as a prescription.