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Coding Questions?

Coding Questions?

Incomplete Procedure

Q During the course of patient care, I routinely perform invasive bedside procedures such as insertion of a non-tunneled central venous catheter, thoracentesis, puncture/drainage of peritoneal cavity, and lumbar puncture (CPT codes 36556, 32421, 49080, and 62270). While I have a pretty good success rate, sometimes my attempts fail. When this occurs, I leave a note detailing my attempt and subsequent inability to complete the procedure. Is there a particular code that I can use to signify these attempts?

A Grab a CPT book and carefully read the description for modifier 53, discontinued procedure. You would add this to the 36556, 32421, etc., if it applies.

Film Review Before Surgery

Q I review X-ray and MRI films that patients bring with them to office visits. Can I charge an additional fee for reviewing these films?

A According to expert coder Bill Dacey, “These are included in the E&M code, counted under the amount and/or complexity of data to review, part of medical decision making.”

Nurse Practitioner Denials From Medicare

Q Recently, Medicare has been denying CPT codes 94010 and 69210 when our nurse practitioner provides the services. She is board certified in family practice. The reason they are giving is denial code B7 — “Provider was not certified/eligible to be paid for this procedure/service on this date of service.”

When we call Medicare they state they do not know why it is being denied. Can you help?

A I can’t say for sure, but if these are some of the few services she provides that are not incident-to and thus billed under her own number, the denial may indicate a problem with her Medicare status/identifier.

Is her number still valid? Is it connected to the group number? Maybe something got messed up in the UPIN transition? I’d look for literal eligibility status first.

Coding for Workers Comp Forms

Q We are just about the only place that does workmans compensation in our area. Is there a special code or charge for that? The forms are such a pain and so time consuming.

A I found the following on an AAPC forum:

“Code 99080 is intended to be used when a physician fills out something other than a standard reporting form, such as paperwork related to the Family and Medical Leave Act. This code does not apply to the completion of routine forms, such as hospital-discharge summaries. Also note that it would not be appropriate to submit 99080 in conjunction with 99455 or 99456, which are the codes for work-related or medical disability evaluation services. The descriptors for these codes explicitly state that they include ‘completion of necessary documentation/certificates and reports.’”

So it looks to me like the forms are specifically included in workers comp claims.

I think the bigger issue than charging patients $10 or scrambling to find a code is making sure you’re handling the whole process as efficiently as possible. Ask patients to fill out as much as possible themselves, assign nonphysicians to much of the rest, and make sure you ask patients upon arrival if the visit is work-related so you get all the information you need.

This answer was provided by Laurie Hyland Robertson, former senior editor, Physicians Practice.

Phone Call Charges

Q I’ve heard I can charge for a phone consultation if it took the place of a visit. For example, a patient called in with a tick bite and we called in a prescription and instructed the patient on its use. Do we just send in a bill? Does it need to say “phone visit” or “consultation”? Is there a code?

A As of 2008, there are CPT codes for telephone care, although some payers aren’t (yet) reimbursing for them. I’d suggest using them anyway. Carefully read the descriptions to codes 98966-98968 and 99441-99443.

Before billing (uninsured) patients for such services, I’d make sure you have a policy in place. Also, think about how people might react if they receive an unexpected bill for something they previously got for free. In other words, you’ll want to start charging going forward rather than retroactively.

This answer was provided by Laurie Hyland Robertson, former senior editor, Physicians Practice.

Defining Trauma

Q Can you clarify “traumatic” versus “nontraumatic” injuries? One of our providers insists traumatic injuries have to have an open wound.

A Traumatic refers to an injury. That injury may have caused, for example, an open or closed fracture.

Take a look in your ICD-9 book. Under Traumatic it says “see condition.” And under Trauma it says “see also injury, by site.”

Determining Fee Schedule

Q What reimbursement rates, as based on a percent of Medicare, should a solo pediatrician in Florida expect from private payers? As you know, the private payers typically base their reimbursement rates on some complicated proprietary methodology or on some percent of some fee schedule for a given Medicare year.

A Well, you will have better info than I.

If you can track what you are getting paid from your EOBs for your main 20 to 30 codes, you’ll be able to identify the percentage of Medicare the going rate is based on and see any real outliers.

You also can consult our annual Fee Schedule Survey.

Using Modifier -59

Q Can you give an example of when modifier -59 is appropriate to append to a procedure? My understanding is that it helps in distinguishing, for example, a separate procedure in a different lobe in the lung or a different branch of the aorta. Can it be applied to E&M services?

A The definition for modifier -59 says it applies to any service or procedure except E&M services.

Documentation has to support “a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury not ordinarily encountered or performed on same day by the same individual.”

Coding for E-Mail

Q Many of my patients drive two hours for an office visit and have started e-mailing me their concerns and questions.

The majority of my patients are on Medicaid support. The e-mail code in the CPT coding book is not covered by Medicaid in my state. Do you have any advice?

A Your instinct/intent to use the new 2008 CPT code for e-mail correspondence is correct per AMA. Unfortunately, if your Medicaid program does not cover it, then not only will it not be paid by them, but the beneficiary is not responsible either.

It is clear from your question that your motivations are good, to perhaps save the patient a long drive and handle some things via alternative methods of communication. However, good motives don’t always result in reimbursement. That payer is not equipped to take advantage of the code or your good intentions. In short, you are stuck.

The only thing I can suggest is that you give your advice as needed, or as time allows, and take the financial hit. You may also wish to look at your malpractice policy and see if it addresses medical advice over the phone or other methods; you may already be proscribed from doing this.

This answered was provided by Bill Dacey, CPC.

Pamela Moore, is director of content and strategy for Physicians Practice. Moore has been writing for physicians on practice management issues for 10 years, and she is a recognized speaker and commentator on healthcare management. She can be reached at pam.moore@cmpmedica.com.

This article originally appeared in the March 2009 issue of Physicians Practice.

 
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