On Tuesday evening, the Senate passed H.R. 4691, which freezes the Medicare conversion factor at current levels through March 31.

Because of this vote, you will not face the 21% pay cut until April 1, explains Part B Insider editor, Torrey Kim. Hopefully by that point, a more permanent fix will have been introduced. “The Senate is working on a bill that would extend the current Medicare payment rate until Oct. 1,” reports this article from the AAFP site.

H. R. 4691 is a “hodgepodge” bill that contains a lot of other provisions in addition to this month’s conversion factor freeze, reports The Wall Street Journal. The bill also extends COBRA’s health insurance subsidies.

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Question: For a chart with a chief complaint of resolving pneumonia, a note indicates, “No coughing, SOB.” Should I give the pediatrician credit for this ‘no coughing & no shortness of breath’ statement under history of present illness (HPI) or as a review of systems (ROS)?

Answer: This is a gray area of E/M coding that you can count under either history type. You could give credit for “no coughing” and “no shortness of breath” (SOB) as associated signs and symptoms under HPI. Some auditors might instead count the notation as a review of the respiratory system under ROS.

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