November 2011
Nebulizer Supplies, Diltiazem IV, Influenza Vaccines with E/M Codes, and Critical Care Coding in Urgent Care
Q.I am using an EHR, but it does not seem to code nebulizer treatments correctly. It produces codes 94640 (nebulizer treatment) and J7620 (albuterol/ipra – tropium bromide), but it misses the codes for administration set, with small volume non-filtered pneumatic nebulizer, disposable (A7003) and tubing (A7011 ). Why is this? A.The administration set code (A7003) and tubing code (A7011) code are actually bundled into the code for the treatment (ie, they are included in 94640). …
Read MoreRule Number One: Code for Services Rendered
DAVID STERN, MD (Practice Velocity) Q.Which CPT codes can be used for diagnosis codes 786.50 (unspecified chest pain) and 414.9 (chronicischemic heart disease-unspecified) to maximize a Medicare patient bill? A.The basic rule of coding is that you should code for the services rendered, not to “maximize a patient bill.” In other words, you should code the best codes that indicate the actual services that were performed. For these codes, you could code for a cardiac …
Read More
October 2011
September 2011
Medical Necessity in E/M Coding, Part 3: Correctly Coding the Physical Exam
DAVID STERN, MD (Practice Velocity) Some coding auditors do not understand the urgent care setting. As a result, they have been inappropriately downcoding evaluation and management (E/M) levels— not based on levels of documentation, but rather on whether the documentation is supported by their “view” of medical necessity, even though these auditors have usually never been providers and lack clinical experience. In this situation, the best defense is a strong offense. This column reviews medical …
Read MoreCan an Urgent Care Use an ED E/M Code and Three Other Coding Challenges
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 MoreJune 2011
Medical 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 More