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 …
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July/August 2009
Proper 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 …
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June 2009
Medication 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 …
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May 2009
Coding 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 …
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April 2009
Modifiers 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 …
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