99212 or 99213 For Podiatry E/M Claims? MDM Level Is Your Key To Success

Posted on 12. Jul, 2012 by dchandhok.

Diabetes patients can present podiatrists with some of their most complex cases and if you don’t evaluate the level of medical decision-making your podiatrist performs for such patients, you can be at risk of undercoding the services—and losing out on money.

Although diabetes patients are regular fixtures in podiatry practices, many podiatry coders inappropriately code the correct E/M level for these visits because they don’t properly evaluate the level of medical decision-making these more medically complex patients require.

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59400, 99212, 99213: How to Add Complication Visits to the Global Ob Package

Posted on 14. Nov, 2010 by jennifer.godreau.

Hint: You can report complications before or after delivery.

You can receive increased reimbursement when your ob-gyn provides additional visits outside of the normal global ob package, but you’ll have to make sure you’ve coded high-risk or complicated obstetrical care correctly – and that means perfecting your ICD-9 coding skills.

Insist on Perfect ICD-9s

You have to link the ICD-9 code on the CMS-1500 claim form (boxes 21 and 24E) to an E/M code, for example, to demonstrate the reason for the additional service. You can add this to the claim that includes the global service, or you can submit it as an additional claim.

Example: A 33-year-old patient, gravida 3, para 2 (both normal spontaneous vaginal delivery [NSVD] full term), is seen in the office 19 times due to developing pre-eclampsia. After the delivery, you review the case and find that the patient required six additional visits (beyond the usual 13) for this care. The documentation for three of these visits supports reporting 99212 (Office or other outpatient visit for the evaluation and management of an established patient … Physicians typically spend 10 minutes face-to-face with the patient and/or family), while three of the visits have more extensive documentation that supports reporting 99213 (Office or other outpatient visit for the evaluation and management of an established patient … Physicians typically spend 15 minutes face-to-face with the patient and/or family).

In addition, after delivery, the patient experiences prolonged pain and irritation due to a hemorrhoid. The ob-gyn sees her for a thrombosed hemorrhoid, which he incises in the office two weeks post-delivery. Finally, the ob-gyn rechecks the patient at her six weeks postpartum visit.

Break it down: When coding for this patient, remember the claim form must note both the CPT codes describing the additional services, as well as the diagnoses that…

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3 Situations Boost Your Migraine Treatment Smarts

Posted on 02. May, 2010 by Editor.

Acute episodes, check-ups are both routine for these patients.

When migraine headache coding comes up, ICD-9 codes typically dominate the conversation.

But what about the procedure codes those complicated migraine diagnoses are attached to? There are several common situations in which a migraine patient might report to the family physician (FP). Check out the top three migraine treatment scenarios, along with expert coding advice on each situation.

Situation 1: Separate E/M and Acute Migraine Tx

One of your FP’s patients might report to the practice with symptoms, and then end up requiring treatment for an acute migraine headache. Consider this example …

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Follow 3 Steps on the Path to Paid Cerumen Removal

Posted on 15. Apr, 2010 by Editor.

Medicare won’t pay 69210 alone, so here’s how to unlock payment.

Impacted cerumen removal is a fairly straightforward procedure, but billing for the procedure is not always so simple.

The problem: Most payers, including Medicare,consider 69210 (Removal impacted cerumen [separate procedure], one or both ears) to be a minor procedure. But unlike with other minor procedures, they only pay for an E/M service as well as the removal of the impacted cerumen when you have two unrelated diagnoses — one for the E/M service and 380.4 (Impacted cerumen) for the removal of impacted cerumen.

The solution:

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Don’t Bill One Physician Incident-To Another

Posted on 09. Apr, 2010 by Editor.

Find out what incident-to requirements you have to meet.

Question: Is there any circumstance in which a group can bill all services and all providers (including other physicians) under just the head doctor? I know we can bill NPP services incident-to another physician, but what about other physicians?

Wisconsin Subscriber

Answer: No, you cannot always bill services for all providers under one of the group’s medical doctors. One reason is because …

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Ensure Multi-Vaccine Payment With This Coding Advice

Posted on 09. Mar, 2010 by Editor.

You may need to append modifier 25, depending on payer policies.

Question: Our physician billed 90634, 90710, and 90606 for vaccines given to a 5-year-old patient. The insurance company denied payment and said they required a modifier. What should we have done differently?

New Hampshire Subscriber

Answer: According to standard CPT coding, vaccine codes do not require modifiers on the associated E/M code. However, you might need to include modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) if your insurance company requires it — which might be why you received a denial.

Well check: If your physician administered vaccines on the same day as a well visit, code the well visit with the appropriate code such as …

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Ob-gyn Coding Challenge: EM End-Result Tells You What ICD Code To Go For

Posted on 03. Mar, 2010 by Editor.

Check out these ICD-10 ob-gyn diagnosis coding equivalents.

Question: A patient presented for an initial OB visit. Another clinic confirmed her pregnancy, but she has never received prenatal care. The patient got her usual initial OB service (i.e. lab orders), Pap smear, and chlamydia trachomatis (CT)/neisseria gonorrhoeae (GC) screening. After discussing some concerns with the patient, the ob-gyn ordered another pregnancy test which came out negative. He ordered an ultrasound (US) which showed no intrauterine pregnancy. The ob-gyn noted bilateral polycystic ovaries, however. In short, the office completed the initial OB visit prior to knowledge of a negative pregnancy test (given the confirmation documentation of a positive pregnancy test). I’m not sure whether to bill it as an initial or an office visit. What code should I use for the first diagnosis?

California Subscriber

Answer: Your clue is to code what you know at the end of the visit. Since the patient was not pregnant, you should report …

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AMA Chimes In On How to Report Consults for Non-Medicare Patients

Posted on 04. Feb, 2010 by Editor.

Beware: Don’t use the CMS consult crosswalk for billing purposes.

You may be seeing light at the end of the tunnel. The AMA just published an article to clarify the use of the consultation codes for non-Medicare patients, and talks about their efforts to get CMS to delay their new policy. You can find the article here.

Watch out …

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How Do I Bill For Follow-Up Visits After the Global?

Posted on 12. Jan, 2010 by .

Tip: Make sure the ICD-9 coding & documentation support follow-up visits after the global.

Question: Code 19101 has a 10-day global period, which means you cannot bill an E/M for anything related to that procedure within that time frame. If the patient continues to have follow-up visits outside the global period, should we then report the appropriate E/M level?

Example: Patient has an open breast biopsy on June 15, so the global period goes through June 25. The patient then has additional follow-up visits on June 26, July 3, and July 10. What is the most appropriate way to bill for the three follow-up visits that the surgeon provides outside the global period? Does modifier 24 apply?

Answer …

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Is 30901 Your Nosebleed Code? Not So Fast?

Posted on 12. Nov, 2009 by sanjay.aikat.

Hint: Look for these keywords in the note to select the correct nosebleed code.

Question: The internist stops a patient’s nosebleed. Is this always a procedure?

Answer: No, if a patient reports with a nosebleed and the physician stops the bleeding with basic methods, you’ll typically opt for the appropriate-level E/M code.

E/M methods: Code minimal attempts at stoppage — including ice or brief, direct pressure — as an E/M service. CPT does not consider these types of treatments separately billable procedures, so an E/M is the way to capture the services the physician provides.

For example, a 62-year-old established patient reports to the internist with an active right-nostril nosebleed that has lasted for three hours. The internist performs a problem focused history and exam, then uses ice and pressure to treat the nosebleed. Read on for how to code this scenario …

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