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, …
Read MoreCoding for Splints, Modifier–QW, Routine Rechecks, and Language Barriers to Efficient Coding
DAVID STERN, MD (Practice Velocity) Q. For splinting, our physicians use Ortho-Glass. At one time we billed out by the inch for it, but now some are saying that you cannot bill for it, as it is included in the E/M level charge. This does not make sense to me, so we’re looking for an expert opinion. Can you help me with this coding dilemma or point me in the right direction? Question submitted by …
Read MoreCoding for ‘Feared Complaint,’ Facility E/M Codes, and Nuances in Complexity of Medical Decision-making
DAVID STERN, MD (Practice Velocity) Q. We recently coded a visit for a young woman who thought – although she had no symptoms or foreign-body sensation – that there was a tampon left in her vagina. On pelvic exam, however, no retained tampon was found. What ICD-9 code is appropriate? Should the physician still diagnose this as a foreign body in the vagina? Question submitted by Japhlet Aranas, Resurrection Healthcare, Illinois A. One should not …
Read MoreWriting Off Patient Responsibility, Modifier-51, and More on New vs. Established E/M Codes
DAVID STERN, MD (Practice Velocity) Q. I listened to your UCA coding webinar, and it raised a question. You mentioned that if we bill insurance for a 99051 and the payor denies payment as “patient responsibility,” then we should bill the patient and not write it off. Does that hold true to the S9088, as well? I often see this code either denied or applied to the patient’s coinsurance/deductible. Question submitted by Megan Fontenot, Integrity …
Read MoreCoding X-Rays Ordered by Outside Docs, G-code for Drug Testing, and 99051 for Scheduled Visits
DAVID STERN, MD (Practice Velocity) Q. We have quite a few primary care physicians who regularly send patients to our urgent care center for x-rays. These patients have a prescription for the x-ray service, and they don’t want to be seen by the urgent care doctor. I have several questions related to this service: Should we collect the urgent care copay (or) radiology imaging services copay (which is usually $0)? Should we code S9083 to …
Read MoreConsult Codes, Injection Codes, and Coding for Diabetes Education and In-House Dispensing
Q. My codes for consults seem to suddenly be getting denied as invalid. I checked my CPT book, and the codes are still listed as valid. What’s going on? Question submitted by multiple urgent care billers A. Yes, you are right that the consultation codes (99241-99245, 99251-99255) are still valid per CPT, as published by the AMA. CMS, however, has decided to no longer reimburse for those codes and has now changed the status indicator …
Read MoreCoding for Two Visits in One Day, Billing for Atypical Urgent Care Services, and Billing on the UB-04
Q. The patient in question is a new patient to the urgent care. At 10 a.m., she visited the urgent care with chief complaint of cough, headache, and myalgias. She was discharged home with a final diagnosis of cough and prescription for ibuprofen and cough syrup. At 3 p.m., she retuned with a complaint of headache and was treated with IM headache medications and sent home with a diagnosis of headache with pain meds. How …
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