DAVID STERN, MD (Practice Velocity) Q.Our doctor saw a patient for a sore throat. The rapid strep screen was positive, so she placed the following diagnoses on the chart: 0: Streptococcal sore throat 61: Fever presenting with conditions classi- fied elsewhere 1: Throat pain 79: Other malaise and fatigue I told her that since we had a specific infection that was the cause of second, third, and fourth diagnoses, we should code the confirmed infection, …
Read MoreICD-9 Changes in 2008
DAVID STERN, MD (Practice Velocity) Q.I noticed that I am getting rejections for the code for fever (780.6). Do I need to add another diagnosis code to get paid? A.There are numerous separate issues related to this code: First, every year ICD-9 updates go into effect on Octo- ber This year was no exception. This code is now sub- categorized as follows: 60 Fever, unspecified 61 Fever presenting with conditions classified elsewhere 62 Postprocedural fever …
Read MoreOf Discounts, Surgical Wound Dressing, and the S9088 Code
DAVID STERN, MD (Practice Velocity) Q.For uninsured patients, how much discount should be given—70% off charges? Particularly in California. A.It would be extremely rare to offer such a big discount to self-pay patients. It would be unadvisable for the following reasons: Unless your fee schedule is ridiculously high, you could not operate profitably at these Discounts should be given not for being self-pay, specif- ically, but for paying in full at time of You will …
Read MoreChoosing the Right Fee Schedule— and the Right Resource
DAVID STERN, MD (Practice Velocity) Q.My office has started to provide urgent care. Should these services be reimbursed at a higher price than for our family practice services? Is there a different fee schedule? Question submitted by Nicole Phelps, First Health Medical, Fresno, CA A.Here is the scoop on coding and reimbursement for urgent care: Some payors will pay more for urgent care services over primary care services, but you will almost cer- tainly need …
Read MoreProper Coding for Skin Tag Removal, Workers Comp Issues, and Off-Hour Visits
DAVID STERN, MD (Practice Velocity) Q.Are you able to bill the following two codes together with a modifier: 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions) 17111 (15 or more lesions)? – Question submitted by Julie Briggs A.These are mutually exclusive codes. You can use 17110 if the physician destroys 14 or less benign lesions (usually warts). …
Read MoreCoding for Services Attempted But Not Completed, and Other Reader Queries
DAVID STERN, MD (Experity) Q.I can’t find any documentation that tells us specifically how we should code when a provider tries to remove a foreign body, but is not successful and decides that the patient should go to the ER. Do we just code for an office visit or do we also code for the removal of the foreign body since the provider did try, albeit unsuccessfully, and decided the patient needed to be seen …
Read MoreThe Finer Points in Determining New vs. Established Patients
DAVID STERN, MD (Practice Velocity) Q.Our urgent care practice serves a 70-physician primary care group. The UC uses the three-year rule; if the patient has been seen by any physician in the medical group within the last three years, he/she is an established patient even if the patient has never been previously seen in the urgent care. A comparable UC center in a nearby city applies the three-year rule differently; if the patient has been …
Read MoreReaders’ Coding Inquiries
DAVID STERN, MD (Practice Velocity) Q.How would you define the difference between an expanded problem-focused exam and the detailed exam in the 1995 evaluation and management coding guidelines? – Question submitted by Eddie Stahl, Medical Staff Director, Tennessee Urgent Care Associates A.For both the expanded problem-focused exam (EPF) and the detailed exam, the provider must document between two and seven body systems. The difference is that the EPF exam requires a “limited” exam of a …
Read MoreDeciphering Payor Language and Other Challenges
DAVID STERN, MD (Practice Velocity) Q.Many procedures, such as injections and fracture care, are reported to patients as “surgery.” Patients sometimes accuse us of false billing, as they don’t consider these procedures to be a “surgery.” How can we fix this problem? A.All third-party payors have installed computer software programs that have code descriptions loaded for each CPT code. Many of these code descriptions are hard to understand, and sometimes they are not truly accurate. CPT …
Read MoreFollow-up Questions Regarding Post – operative Care and ‘Established’ Patients
DAVID STERN, MD (Practice Velocity) Q.I was curious about your response to a case listed in Coding Q&A in the November issue of JUCM. The case described a patient who returned for reopening of a wound due to infection. The physician then cleansed and re-sutured the wound. Although I agree about the postoperative care in general, I wonder if modifier -79 would be appropriate in these circumstances. According to instructions by the AMA, this modifier …
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