DAVID STERN, MD (Practice Velocity) Q.Can 99283 and 99214 procedure codes be used for an urgent care visit? The codes were used by an urgent care facility, and I am told that 99283 is categorized as an emergency room code. A.Code 99283 is for an emergency department visit for the evaluation and management of a new or established patient with an expanded problem focused history and examination and medical decision making of moderate complexity. Code 99214 …
Read MoreMedical Necessity in E/M Coding, Part 2: ROS and PFSH
DAVID STERN, MD (Practice Velocity) Last month, we presented definitions for medical necessity offered by the AMA and the Centers for Medicare & Medicaid Services (CMS). We looked at the elements appropriate to perform and document in the History of Present Illness (HPI). And we briefly discussed Recovery Audit Contractors (RAC) audits. (If you missed it, the column is archived on the JUCM website [https://www.jucm.com] in the May 2011 issue.) This month, our focus is …
Read MoreMedical Necessity in E/M Coding
DAVID STERN, MD (Practice Velocity) Q.Recently some of my charts were audited and the payor challenged the levels of the evaluation and management (E/M) codes I had used. The payor said that the charts were actually coded correctly, based on the information that was documented on the chart. The auditor, however, challenged what she called the “medical necessity” of the documentation. She claimed that, based on the patients’ chief complaints, many elements of the E/M …
Read MoreS9088 Coding for Medicare or Medicaid, Coding for SVT, and Coding 99211
DAVID STERN, MD (Practice Velocity) Q.In one of your articles concerning the S9088 code (services provided in an urgent care center), you indicate this code cannot be billed to Medicare or Medicaid. However, I read in another source that S9088 and S9083 (global fee for urgent care centers) had been approved by the Centers for Medicare and Medicaid Services (CMS) for billing these services. What is the current status of these codes as they relate …
Read MoreCoding Concerns: Versajet Debridement, Time Frame for New/Established Patients, Detailed Exams, Denial of S9088, –57 Modifier, and Billing for Injections
DAVID STERN, MD (Practice Velocity) Q.How do I code when using Versajet to debride an ulcer? A.For Versajet debridement, you should report CPT code 97597 (removal of devitalized tissue from wound(s), selective debridement, without anesthesia (e.g., high-pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel, and forceps), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area less than or …
Read MoreCoding for Intravenous Infusion, Fees for S9083, Morgan Lens Irrigation, and UB-04 Revenue Codes for Urgent Care
DAVID STERN, MD (Practice Velocity) Q.I had a patient come in who needed IV fluids and monitoring for five hours. We found the CPT codes 96360 (intravenous infusion, hydration; initial 31 minutes to 1 hour) and 96361 (each additional hour…) to use for the IV hydration therapy. However, my doctor cannot believe how low these codes are reimbursed by his health insurance. We did bill an office visit in addition to the IV. Is this …
Read MoreCoding for Complicated or Multiple I&Ds, Head CT, and Follow-ups— and When to Use CPT 99051
DAVID STERN, MD (Practice Velocity) Q. I notice that the code for complicated or multiple incision and drainage (I&D) procedures almost twice the reimbursement as the superficial I&D code. When can I code the code 10061 (Incision and drainage of abscess, e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia; complicated or multiple)? Anonymous A. The concept of multiple (i.e., more than one) is straightforward. The concept of complicated I&D is less …
Read More‘Destruction’ Codes, Global Periods, Working with Provider Representatives, and Denial of G0431-QW
DAVID STERN, MD (Practice Velocity) Q. Our physician did a shave excision and sent it to pathology. It came back as malignant. She now wants to bill using the destruction codes of 17260-17286. We coders are trying to tell her that she needs to bill for the shave excision, because she documented clearly that she performed shave excision. What is the correct way to bill for this procedure? Name withheld A. Per CPT Assistant 2009: …
Read MoreICD-9 Updates for 2011
DAVID STERN, MD (Practice Velocity) Updates to the ICD-9 code set went into effect October 1, 2010. There will be one more regularly scheduled ICD-9 update on October 1, 201, the vastly larger ICD-10 code set is scheduled to take effect. The following are changes that are of particular interest to us in the urgent care field: New code to specify post-traumatic seizures: When a patient experiences seizure(s) as a result of a head injury, …
Read MoreCoding for Rectal Strep and Injury Exposure Visits, Billing for Slit Lamp Exams, and a Follow-up on Splinting
DAVID STERN, MD (Practice Velocity) Q. What is the correct ICD-9 code for rectal strep? Question submitted by Cindy Reisbeck, Littleton, CO A. There are several possible codes. The specific ICD-9 code would depend on a more specific diagnosis. For streptococcal infections in the rectal or perirectal area, there are several possible correct codes, as streptococcal species can cause multiple different types of localized conditions. For cellulitis, the correct code would be 566; for erysipelas, …
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