Tag Archives: 99214
Posted on 02. Feb, 2011 by dchandhok.
Level-four and level-five office visits are not unusual in a urology practice, but failing to incorrectly match the history, exam, and medical decision-making (MDM) can make you miss out on the higher level codes you could report.
The third element for the historical portion of an E/M service, after the chief complaint (CC) and the history of the present illness (HPI), is the review of systems (ROS) — this portion of the E/M service trips up many coders because often they must select a lower code simply because the provider didn’t document pertinent negative responses or inappropriately used the statement “all systems negative.”
Ensure you’re properly counting your urologist’s ROS with this primer to guarantee you’re not overcoding or undercoding his E/M services.
“The review of systems is a subjective account of a patient’s current and or past experiences with illnesses and or injuries affecting any of the 14 applicable organ systems,” explains Nicole Martin, CPC, manager of the medical practice management section of the Medical Society in New Jersey in Lawrenceville.
You’ll need to know the differences between the
Posted on 10. Mar, 2010 by Editor.
Are you clear on how to report asthma procedures and inhalers? Follow this advice, and you’ll breathe easy when it comes to asthma related claims.
Propellant-Driven Inhaler Falls Under 94664
If there’s confusion in your office over whether to use 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler, or IPPB device) to report education/training with the Advair diskus, look no further for your answer.
Code 94664s descriptor specifies demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device. Part of teaching the proper technique in using an inhaler (either propellant-driven [Advair Diskus] or dry powder) is to demonstrate and evaluate. In this respect, the code would seem appropriate to use for demonstration and evaluation, say sources with the Joint Council of Allergy, Asthma & Immunology.
Posted on 09. Mar, 2010 by Editor.
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 …
Posted on 19. Feb, 2010 by Editor.
Overlooking time as the key factor on a camp or sports exam in which the patient has a problem could cut $30 per claim.
Opportunity: An office visit (99201-99215, Office or Other Outpatient Services) using time as the key factor might be appropriate, but keep in mind that lowballing time-based E/M codes because of poor documentation can be a revenue-loser for many practices, says Jennifer Godreau, who’s presenting a free webinar next week to help coders tackle trouble-spots.
Watch for Chronic Conditions
Posted on 31. Jan, 2010 by Editor.
Counseling representing more than 50 percent of E/M visit? Choose level based on time.
Question: I have a family physician who documented 60 minutes on an established patient’s office visit. The FP diagnosed the patient with morbid obesity (278.01). Since the patient was newly diagnosed and had some difficulty understanding the doctor’s orders, the FP spent more than half the office visit time on counseling on therapeutic lifestyle changes and the treatment regimen. Should I code this as 99214 for the first 25 minutes and +99354 for the remaining time?
Posted on 10. Aug, 2009 by .
Question: My orthopedist treated a patient who was first seen in the ER for an open fracture with laceration overlying the distal finger phalanx. The ER physician sutured the wound. When the patient arrives in our office, the orthopedist does an E/M service and assumes the care of the wound in addition to the fracture care. Should I report our orthopedist’s E/M service or does that qualify as double-dipping?
Answer: If your orthopedist didn’t do anything in addition to treating the fracture (such as splinting, casting, and so on), then you should bill the E/M service (such as 99214, Office or other outpatient visit …). You might try applying modifier 55 (Postoperative management only), but you need to make sure the service the ER physician performed has more than a “0” day global. Many wound repair codes are minor procedures that have 10 day global periods.
If your orthopedist treated the fracture, you should report the appropriate fracture code. Your facture code could be 26750, Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each, or 26755, … with manipulation, each, depending on whether the orthopedist performed the manipulation).
Posted on 29. Jul, 2009 by atif.adnan.
Good news: You can report a higher-level (and higher-paying) E/M in this annual-visit situation.
Annual visits often lead to confusion when it comes to establishing a patient’s pregnancy. Take this 3-part challenge by deciding if the ob-gyn package begins based on these scenarios:
• a patient’s annual visit leads to a diagnosis of her pregnancy,
• she arrives knowing that she is pregnant, or
• the ob-gyn eliminates other possible diagnoses.
Hint: In the majority of circumstances, you should not begin counting antepartum visits for the global maternity codes (59400, 59510, 59610, 59618) until the next full visit, coding experts say.
Still Report Annual When Visit Leads to Pregnancy Dx
Scenario 1: If the ob-gyn diagnoses pregnancy (V72.42, Pregnancy examination or test, positive result) during a patient’s annual exam (99384-99386 for new patients, or 99394-99396 for established patients), you can still report the annual examination, as long as you link the pregnancy diagnosis to the diagnostic test (for instance, 81025, Urine pregnancy test, by visual color comparison methods).
Posted on 01. May, 2009 by .
Checklist deters payback requests for insufficient +99354 time.
After spending almost an hour stabilizing an acute asthmatic, an extra $60 can be in store provided you make the right choice between coding prolonged services or a higher-level E/M.
Do you understand all your opportunities for ethically boosting reimbursement in your pediatric practice? Join Dr. Richard Tuck, Deborah Grider, Jennifer Godreau, Donnelle Holle & other experts at our 2009 Pediatric Specialty Coding Conference.
Case study: A patient requires two nebulizer treatments and lengthy treatment time due to hay fever with exacerbated asthma (493.02, … extrinsic asthma; with [acute] exacerbation). Which of the following E/M options, would you report?
Posted on 06. Apr, 2009 by .
Evaluation and management services represent the bulk of what most practices bill these days. So if your E/M coding knowledge isn’t up to snuff, your practice could be missing out on major reimbursement or risking compliance issues.
Find out if you’re properly billing the E/M services your physicians perform with these five quiz questions, then see below for the answers.
Question 1: The physician puts an asthma patient on steroids and changes his inhaler settings after an exacerbation. The patient returns the next week for a scheduled follow-up. The provider asks the patient if he is having any breathing trouble since his medication change. What review of systems (ROS) level does this represent?
Posted on 18. Mar, 2009 by .
Still don’t have V61.0___ on your superbill? Your E/M levels could be suffering.
“Pediatricians frequently deal with dysfunctional families,” and the family disruption series, V61.0x, helps support work done within these codes’ described issues, says Richard Tuck, MD, pediatrician at PrimeCare of Southeastern Ohio in Zanesville. Using a counseling diagnosis often supports a higher level of CPT coding for these time-dominated visits.
If you’re sold on reporting family disruption diagnoses, get started here.
Discover 7 Disruption Types
“Going along with our times,” ICD-9 2009 added codes for family disruption, explained Katie Arnold CPC, CPC-H, CPC-IM, in her update presentation at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.
Effective Nov. 1, 2008, V61.0 was deleted and was expanded into seven codes for “family disruption due to ….” For an encounter needed for a family member on military deployment, you can use V61.01. “You’ve got a code for disruption due to return of family member from military deployment (V61.02),” points out Arnold, who is manager of coding education and QA at DHMC. Other codes include disruption due to …