Q. We are afraid of getting denials for using unspecified ICD-10-CM [International Classification of Diseases, 10th Revision, Clinical Modification] codes. In an urgent care center, we sometimes will see a particular patient only one time for minor illnesses and injuries, and follow-up with their primary-care physician is always advised. Do you have any advice on documenting to get claims paid? A. Within ICD-10-CM, you may select codes defined as “Not Otherwise Specified” (NOS). Generally, this should …
Read MoreTravel Immunizations
Q. What is the best way to code for and bill patients who come in because they are planning to travel out of the country and need to know what immunizations they should have before traveling? We advise them on preventive measures to take in relation to where they are traveling, provide literature if appropriate, and even try to find health-care facilities close to where they will be staying while abroad. I know we can …
Read MoreOpen Fracture Treatment Versus Closed Fracture Treatment
Q. We had a patient come in with an open fracture of the distal interphalangeal joint of the right index and middle fingers, ICD-9 [International Classification of Diseases, 9th Revision, Clinical Modification] code 816.12. The provider set and splinted them both. Can I bill procedure code 26765 (“Open treatment of distal phalangeal fracture, finger or thumb, includes internal fixation, when performed, each”) twice? A. A diagnosis of open fracture means that the skin has been …
Read MoreElectrocardiogram Data Points and Evaluation and Management Visit Level; Gait Training
Q. When counting data points for the complexity of medical decision-making (CMDM) portion of the evaluation and management (E/M) visit level, what is the correct way to assign data points for an electrocardiogram? For example, the Current Procedural Terminology (CPT) code is 71020 for a chest radiograph with interpretation and report. The description itself has the interpretation and analysis included in the code already. Is it considered double-dipping if we count the interpretation as 1 …
Read MoreFractures in ICD-10-CM
Q. We treat a lot of fractures in our urgent care clinic, and I understand there are changes for coding these in ICD-10-CM [International Classification of Diseases, 10th Revision, Clinical Modification]. What will we need to be aware of? A.Most of the changes made in ICD-10-CM were to chapter 19, “Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88),” because of the need to identify laterality and 7th-character extensions that indicate the type of …
Read MoreIntravenous Therapy
Q. We perform a lot of intravenous (IV) infusions in our urgent care facility. Sometimes we also perform IV pushes and hydration at the same time as the infusion. What is the correct way to code multiple IV infusions? Do we have to document start and stop times for each IV service? A. If an IV infusion and IV push are performed concurrently in the same IV site, you should only bill one “initial” code. …
Read MoreRib Fractures, Joint Injections and Aspirations, Sports Physicals, and Tuberculosis Skin Tests
Q. What code do we use now to bill for closed treatment of a rib fracture? A. In 2015, Current Procedural Terminology (CPT) deleted codes 21800, “Closed treatment of rib fracture, uncomplicated, each,” and 21810, “Treatment of rib fracture requiring external fixation (flail chest),” because of lack of use. You are now to report closed treatment of an uncomplicated rib fracture using an appropriate evaluation and management (E/M) code. Q. We perform many joint injections …
Read MoreModifier -X {EPSU}, Pneumococcal Immunizations
Q. Have there been any updates from CMS (Centers for Medicare & Medicaid Services) regarding the new -X modifiers that were introduced in January of this year? A. CMS released MLN Special Edition article SE1503 on January 22, 2015 (see http://www.cms.gov/Outreachand- Education/Medicare-Learning-Network-MLN/MLN MattersArticles/Downloads/SE1503.pdf), stating that there would be forthcoming guidance as to the appropriate use of the new -X {EPSU} modifiers and “that guidance will include additional descriptive information about the new modifiers” before implementing …
Read MoreFracture Codes, Strapping and Splint Application Codes, S9088
Q. I was told that we can no longer use code 80100 for drug screens. We have several employers who send employees and potential employees to our urgent care center for pre-employment, random, and post-accident drug screens. What code should we use now? A. Effective January 1, 2015, several drug-screen Current Procedural Terminology (CPT) codes were deleted by the American Medical Association: 80100: “Drug screen, qualitative; multiple drug classes chromatographic method, each procedure” 80101: “. …
Read MorePayor Contracts, Discounts, and Provider Signatures
Q. We sometimes have patients come in to our urgent care center with an insurance payor that we do not have a contract with. We do not want to turn them away, but we do want to guarantee our payment. Do we have to submit a claim to the insurance company in such cases? Currently, we offer these patients a self-pay discount, and they pay us in full at the time of service. A. Typically, …
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