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• Q: Determining Part time and Full Time Status for Benefit Eligibility?
• Q: A patient while in the office cried and told x-ray tech that her husband caused her broken wrist. What is the practice staff to do? Do we need to report the incident to the police?
• Q: A patient of ours came in with a proximal femoral shaft fracture and we coded it 27245 – IM fixation subtrochanter fracture. Should we code this differently?
• Q: For a shoulder decompression, is it better coding a 29826 or 29823?

Q: How do I determine how to classify my employees as part time vs full time to determine benefits eligibility?

A: Please review information provided in

http://www.twc.state.tx.us/news/efte/part_time_full_time.html

Part-Time / Full-Time Status

1. Texas and federal laws leave it up to an employer to define what constitutes full-time and part-time status within a company and to determine the specific schedule of hours.
2. Most companies define full-time employees as those who are regularly scheduled for a set number of hours each week (40, 37.5, 45, or similar amount), and part-time status is for anyone who is regularly scheduled to work less than that amount of time each week.
3. A common reason for differentiating between part-time and full-time employees is to distinguish the set of employees who receive company benefits from those who are not eligible for such benefits, or to supply a way of distinguishing between two sets of benefits for two classes of employees. It is legal to have one set of benefits, or none at all, for part-time employees, and another set of benefits for full-time employees, as long as there is equal employment opportunity within the company.
4. Certain benefits have specific rules, however:
   • Pension or retirement benefits – if a company offers such benefits, the federal law known as ERISA provides that an employee who works at least 1,000 hours in a twelve-month period must be given the chance to elect participation in the pension or retirement plan (this is known informally as the “thousand-hour rule” – see 29 U.S.C. § 1052)
   • Health insurance benefits – if an employer has a health insurance plan, Rule 28 T.A.C. § 26.4(15) provides that an “eligible employee” is anyone who usually works at least 30 hours per week
5. Having part-time/full-time definitions that are insufficiently specific can lead to a problem of interpretation, if the workplace gets busy for more than a week or two at a time, and employees who are hired as part-timers have to work 40 or more hours several weeks in a row. Such employees might begin to think of themselves as full-time employees and expect full-time benefits. For that reason, some employers write the definitions in a manner similar to this:
   
   “Full-time employees are those who are regularly assigned to work at least 40 hours each week. Part-time employees are those who are regularly assigned to work less than full-time. While part-time employees may occasionally work 40 or more hours in a particular workweek, or in a series of workweeks, that by itself will not change their regular schedule. However, the company reserves the right to change the regular schedules of employees at any time. In such a case, the company will give affected employees as much advance notice as possible of their new regular schedules and will advise employees of the effect of such changes on their eligibility for company benefits.”

Q: A patient while in the office cried and told x-ray tech that her husband caused her broken wrist. What is the practice staff to do? Do we need to report the incident to the police?

A: (Provided by TMLT Insurance on behalf of Gallager Healthcare)

Below is the obligation medical professionals have when treating a patient caused by family violence. The state has completely different rules for elder abuse and child abuse. I didn’t want to send you a bunch of links to sift through, so let me know if you need that information too.

FAMILY CODE

TITLE 4. PROTECTIVE ORDERS AND FAMILY VIOLENCE

SUBTITLE C. REPORTING FAMILY VIOLENCE

CHAPTER 91. REPORTING FAMILY VIOLENCE

Click here for more information

Sec. 91.003. INFORMATION PROVIDED BY MEDICAL PROFESSIONALS. A medical professional who treats a person for injuries that the medical professional has reason to believe were caused by family violence shall:

1. immediately provide the person with information regarding the nearest family violence shelter center;
2. Document in the person’s medical file:
   • The fact that the person has received the information provided under Subdivision (1); and
   • The reasons for the medical professional’s belief that the person’s injuries were caused by family violence; and
3. Give the person a written notice in substantially the following form, completed with the required information, in both English and Spanish:

It is a crime for any person to cause you any physical injury or harm even if that person is a member or former member of your family or household.

A patient of ours came in with a proximal femoral shaft fracture and we coded it 27245 – IM fixation subtrochanter fracture. Should we code this differently?

Click here for more information

Q: For a shoulder decompression, is it better coding a 29826 or 29823?

29826 = 5.07 RVUs; 29823 = 17.9 RVUs

If you code 29823 with another procedure, you will take a multi-procedure discount of at least 50%. But you still get more RVUs for 29823.

However, 29823 typically bundles to all other shoulder codes whereas 29826 does not. So, there is a chance that 29823 will deny on first pass and require an appeal. That is not the case for 29826 since it is an add-on code. And because it is an add-on code, it is not subject to a multi-procedure discount. All-in-all, recommend code is 29826 for a subacromial decompression with an acromioplasty if billed with other shoulder codes (including 29823 if you do soft tissue debridement on at least 2 other tendons or other areas of the shoulder). If you do not do any “bony work” on the acromion, then I would recommend a 29822 or 29823 (some carriers require that the “amount” of bony material removed is documented in order to get 29826 paid). For example, if you only do a bursectomy and do not do an acromioplasty, then recommended code is 29822. If you do additional soft tissue work, then you could bill 29823.

One last note.. In 2013 Medicare added an update to the NCCI edits which prohibits the use of 59 modifiers on shoulder codes. For this reason, we are not coding 29822 or 29823 or any other code that would require a 59 modifier when billed with other shoulder codes. Even though these codes might be paid on first pass with a 59 modifier, it would eventually flag for a RAC audit. The same is true for knee chondroplasties when performed with a meniscectom. Medicare has indicated that the chondroplasty is included, regardless of the compartment in which the procedure was performed. Thus, FTGU is not billing G0289 for a chondroplasty with 29880 or 29881.