Q. The following example is a common occurrence in our urgent care center when billing workers compensation (WC) claims: Patient A comes to the urgent care center for treatment of injuries sustained while on the job with Employer B. Patient A says, “My boss sent me here because it was close.” Now, Patient A has no insurance, no claim number, and no authorization for treatment, just his employer’s name and a supervisor’s name. Who is …
Read MoreE/M for Sinusitis and Pharyngitis
Q. The clinic I work at uses 99214 for most patients (50%) for sinusitis and pharyngitis. Is this a common code to use for these problems? A. The E/M levels of services recognize sevencomponents: History Examination Medical decision making Counseling Coordination of care Nature of presenting problem Time The history, examination, and medical decision making are considered to be the key components in selecting a level of E/M service. Counseling, coordination of care, and the …
Read MoreNew vs. Established Patients, Medicare Exam, ICD-10 Delay
Q. A patient with Medicare as his primary insurance needs a physical and EKG for clearance for an MRI with sedation ordered by his neurologist. Symptoms are imbalance along with pain in the shoulder, neck, and upper spine. Can I use the pre-op code V72.81 because there is sedation even though there is no actual surgery? Or should I just get a signed Advanced Beneficiary Notice (ABN) and expect a denial? A. Yes, you can …
Read MoreDME, Benign Lesion Excision, Urgent Care Codes
Q. We currently provide DME to our patients as a courtesy to them and then bill their insurance. We generally get paid by most private insurances, but not by Medicare. Our billing department claims Medicare will never pay for any DME we provide because we are not a DME provider licensed with Medicare. If our billing department is correct, would it be compliant to give DME prescriptions to all patients 65 and over? A. I …
Read MoreMDM, E/M Code with Injection Codes
Q. I was approached by a member of the hospital billing department who does urgent care (office based practice) and emergency department billing about a coding question. As the medical director, they asked for my thoughts and support. It’s nice to work at a place that includes the docs! The question revolves around prescription drug management within the management options under the medical decision making (MDM) section pertaining to E/M calculation. We currently do not …
Read MoreUrgent care codes, E/M Guidelines, ICD-10
Q. Is there a defined set of diagnosis codes for urgent care services and is there a diagnosis code that indicates the services were urgent? A. All facilities use the same set of ICD-9 codes to report the patient’s diagnosis. There are no diagnosis codes to represent urgent care services, but there are certain procedure codes you can use to indicate that services were rendered in an urgent care clinic and also procedure codes to …
Read MorePulse Oximetry, Oral Medication
Q. I am reviewing documentation for a freestanding urgent care center that performs pulse oximetry on every patient they see, regardless of the reason. Is this typical? In some cases, they are billing the case rate code, S9083. Please let me know if this is standard operating procedure. A.Medicare will allow payment for pulse oximetry under two conditions: 1) when it is linked to an appropriate diagnosis code; and 2) if it considered as being …
Read MoreICD-10
Q. My staff keeps telling me that my documentation will have to change in order for them to properly choose an ICD-10 diagnosis code. Is that true? A. Documentation practices should not have to change but it will be helpful to understand the granularity of the new codes. There is greater specificity including laterality, temporal factors, contributing factors, symptoms, manifestations, and anatomic location. Thus, if you currently gloss over details in the medical record, you …
Read More2014 CPT Changes, Suture Removal, Place of Service Code
DAVID STERN, MD (Practice Velocity) Q. I understand that we will be able to bill for cerumen removal for both ears in 2014. Is that true? A.Yes. In 2014, you will be able to bill CPT code 69210, “Removal impacted cerumen requiring instrumentation, unilateral” with modifier -50, “Bilateral procedure.” Keep in mind, Medicare will typically not cover simple, non-impacted earwax removal. CMS requires that physicians meet the following criteria for reimbursement of the removal of …
Read MoreCoding Intravenous Infusions with Hydration; Medical Decision Making
DAVID STERN, MD (Practice Velocity) Q. We perform a lot of IV infusions in our urgent care facility. Sometimes we also perform IV pushes and hydration at the same time as the infusion. We have been billing CPT codes 36000, 96365 -59, 96360 -59, and 96374 -59. Medicare pays for these codes when we append the -59 modifier but I am concerned that this may not be the correct way to bill after reviewing some …
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