DAVID STERN, MD (Practice Velocity) Q. We offer Physical Therapy services to patients in our urgent care center and some patients have Medicare insurance. I understand there are new codes that we must use for Medicare. What are they and how do we use them? A.The Centers for Medicare and Medicaid Services (CMS) was mandated by the Middle Class Tax Relief Act of 2012 to collect information regarding beneficiaries’ function and condition, therapy services furnished, …
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June 2013
Foreign Body Removal, Hydration, and Minor Surgical Procedures with E/M
DAVID STERN, MD (Practice Velocity) Q. We removed an earring that was imbedded in the pinna using general anesthesia? Can we bill CPT code 69205? A.No. CPT code 69205, “Removal foreign body from external auditory canal; with general anesthesia,” is limited to the external auditory canal. The pinna, which also may be referred to as the auricle, is not considered a part of the auditory canal. If an incision was made to remove the embedded …
Read MoreMid-level Providers, Resident Providers, Non-payment for S9088, Non-payment for E/M 99205, POS -20 for Family Practice
DAVID STERN, MD (Practice Velocity) Q. Our urgent care is staffed by nurse practitioners (NP) 6 days per week and all of the billing is processed under the medical director for all insurance companies. I have three separate questions: Is it legal for a new Medicare patient entering the ur- gent care setting to be billed under the medical direc- tor if he is not on site and has never seen the patient? Is it …
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May 2013
Primary Care in the Urgent Care Setting, E/M Codes With Other Services, Penicillin Injection
DAVID STERN, MD (Practice Velocity) Q. Can physicians see regular patients and schedule routine care at urgent care facilities? If so, can the urgent care center bill for those services at a separate, lower rate than the urgent care rate? A.Special attention should be paid to payor contracts in these situations. If the insurance company views your patient’s visits as urgent care even though you provided primary care, the patient could be responsible for higher …
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April 2013
Modifier -25 and Urgent Care Codes
DAVID STERN, MD (Practice Velocity) Q. Can a patient be billed for an E/M code and an ultrasound procedure such as 93970, “Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study” during the same visit when both the scan and the E/M visit were performed by the same provider? A. If during an office visit it is determined that the ultrasound procedure needs to be performed on the same …
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March 2013
S9083, Radiology, and E/M Codes
DAVID STERN, MD (Practice Velocity) Q.Can CPT code S9083 be billed with an E/M service code or would this be considered double dipping? You would not typically add CPT code S9083 to an E/M service unless instructed to do so specifically by an insurance company. CPT code S9083, “Global fee urgent care centers,” would be used in instances where the insurance company has stated that the reimbursement is based on a flat rate (global fee …
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