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 …
Read MoreSupervising Physician, Physician Rotation, Critical Care
DAVID STERN, MD (Practice Velocity) Q. Can a Physician Assistant (PA) bill a claim under a supervising physician even when the supervising physician is not physically present during the patient visit? A.A PA can render services when the physician is not on site. Incident-to billing (a specific CMS method for billing midlevel services with the physician as rendering provider) would never apply in this case. Services rendered in this situation should be billed with the …
Read MorePreventive Medicine, Preventive Medicine Counseling
DAVID STERN, MD (Practice Velocity) Q. How do you code for a Sexually Transmitted Diseases (STD) screening visit in a patient who has no symptoms? Can you use a preventive medicine code (99387-99397) and still receive reimbursement? A.You would code based on the service provided. If you performed a physical and collected the specimen to send to the lab, then you would bill the appropriate preventive medicine Evaluation and Management (E/M) code. If the only …
Read More2013 Physical Therapy G Codes
DAVID STERN, MD (Practice Velocity) Q. We offer Physical Therapy services to patients in our urgent care center and some patients have Medicare insurance. I understand there are new codes that we must use for Medicare. What are they and how do we use them? A.The Centers for Medicare and Medicaid Services (CMS) was mandated by the Middle Class Tax Relief Act of 2012 to collect information regarding beneficiaries’ function and condition, therapy services furnished, …
Read MoreForeign Body Removal, Hydration, and Minor Surgical Procedures with E/M
DAVID STERN, MD (Practice Velocity) Q. We removed an earring that was imbedded in the pinna using general anesthesia? Can we bill CPT code 69205? A.No. CPT code 69205, “Removal foreign body from external auditory canal; with general anesthesia,” is limited to the external auditory canal. The pinna, which also may be referred to as the auricle, is not considered a part of the auditory canal. If an incision was made to remove the embedded …
Read MoreMid-level Providers, Resident Providers, Non-payment for S9088, Non-payment for E/M 99205, POS -20 for Family Practice
DAVID STERN, MD (Practice Velocity) Q. Our urgent care is staffed by nurse practitioners (NP) 6 days per week and all of the billing is processed under the medical director for all insurance companies. I have three separate questions: Is it legal for a new Medicare patient entering the ur- gent care setting to be billed under the medical direc- tor if he is not on site and has never seen the patient? Is it …
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