March 2010
Consult 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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February 2010
Coding by Time, for Emergent Care, and for Nurse Practitioner Visits
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 …
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December 2009
S9083 & 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 …
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