Q. How does one determine whether an E/M code can qualify for coding according to time spent? Obviously, any psychiatric counseling would fit the criteria, but what about “teaching” (e.g. how to use an inhaler, how to perform a breast exam), or preventive medicine counseling? – Question submitted by Dr. Kim, Med7 Urgent Care, CA A. The key issues on counting counseling or coordination of care toward the E/M code are: Counseling and/or coordination of …
Read MoreSplint Applications by Staff, and Proper Use ofModifiers -25, -26, and -59
Q. At the UCA Fall Urgent Care conference, you welcomed all questions, so here goes: Can you please let me know if it is appropriate to charge for Ortho-Glass and fiberglass splints in the urgent care setting? In some cases, the splints are applied by a tech under the direct supervision of the physician. In other cases, can the charge for the application of the splint be coded in addition to the Q code? Question …
Read MoreS9083 & Secondary Insurance, Laceration Repair, and More
Q. We bill S9083 to several carriers. Occasionally, a patient will have secondary insurance. If the primary insurance is contracted to pay S9083 code but transfers the balance to the deductible, how do we bill the secondary carrier if they do not accept the code? Question submitted by Paula Seify, Back Office MD A. Many secondary payors do not accept S9083, but these payors still will often cover the actual services that were rendered under …
Read MoreCoding for I&D, DTaP, and Procedures Included in the E/M Code
Q. An urgent care that I do billing for has presented a question I would like your input on. A sales rep has stated that urgent care centers are now administering DTaP in urgent care, and, if so, what is the difference between the reimbursement of the Td (90714) and the DTaP (90715)? Lynn Gray, Eastern Hills Medical Billing, Cincinnati, OH A. Patients may use urgent care centers when they have difficulty getting timely appointment …
Read MoreProper Use of 99051, and the Status of S9088
Q. Can I bill the CPT code 99051 (Services(s) provided in office during regularly scheduled, weekend, or holiday office hours, in addition to basic service) for the purpose of getting a denial? Can I bill a Medicare patient for the 99051 code if I have an advanced beneficiary notice (ABN) completed? Anonymous, Texas A. This is a very interesting question, and I am sure it will generate significant controversy. In regard to your question about …
Read MoreMedication Supplies, New Patient E/M, and Skin Shaving Vs. Skin Biopsy
Q. On our new superbill, there is a spot to code for Phenergan (generic is promethazine HCI) 50 mg when administered intramuscularly. How would we code for Phenergan when the physician orders Phenergan 25 mg IM? Do we mark the code x ½? Anonymous, Illinois A. If you administer 50 mg of promethazine or any portion of 50 mg, then you use code J2550 (injection, promethazine HCI, up to 50 mg). For example: 25 mg …
Read MoreCoding for Observation, and More on Established vs. New Patients
Q. Is it possible for observation status codes (99217-99220) to be billed in an urgent care facility? A. Observation codes will require the point of service (POS) to be a hospital. If your urgent care is operated by a hospital and you can legitimately use a hospital POS, then you may be able to use these codes. If you use the physician office (POS-11) or urgent care (POS-20) place-of-service codes, then you could not use …
Read MoreModifiers for E/M Codes During Global Periods
Q. What is the official definition of “global period” as it applies to procedures in the urgent care center? When can we code an E/M in addition to the procedure? A. The actual definition of the global period differs slightly when it is defined by the AMA (CPT) and when it is defined by CMS (Medicaid/Medicare). CPT codes are published and copyrighted by the AMA. According to CPT as it applies to services rendered in …
Read MoreAn Update on New vs. Established Patients
David Stern, MD Q.I read your column about new vs. established patient coding in the January Issue of JUCM. Although the information provided was correct at one time, I believe that Medicare has updated its algorithm to come closer to the algorithm provided by AMA for new vs, established patients. A.You are correct. In a somewhat obscure and rarely referenced information release. (www.cms.hhs.gov/MLNMattersArticles/downloads/MM4032.pdf) CMS did change its position on this issue. “Physicians should not that …
Read MoreDetermining New vs. Established Patients for E/M Coding
Q.We are in the process of adding urgent care services to our occupational medicine clinic. How do we determine when to use a new or established E/M code for the patients who are seen for urgent care services? A.I continue to receive questions regarding the “when to code new or established patient E&M codes” conundrum, so let’s try to simplify the issue. The official CPT definition of new patient is: A patient who has not …
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