Q. When a patient comes in with ear pain due to impacted cerumen, the health-care provider would normally instruct the nurse to perform ear irrigation. If the irrigation successfully removed the impacted cerumen, the procedure would be considered part of any evaluation and management (E/M) service and we could not bill for the service separately. With new rules regarding cerumen removal this year, can we get reimbursed for the ear irrigation if it is not …
Read MoreFracture Care
Q. Will you please help me understand initial visit, subsequent visit, and sequelae related to fracture care? If the patient is treated elsewhere for a fracture and the provider just stabilizes the fracture and instructs the patient to then come to my office for reduction, is this a subsequent visit or an initial visit? A. International Classification of Diseases 10th Revision, ClinicalModification (ICD-10-CM) guidelines state that a seventh character, A, is used for the initial …
Read MoreProlonged-Service Codes
Q. The coding staff has relayed to me that we can now bill for times when my clinical staff must spend extra time with a patient. Is this true? What are the requirements for documentation? A. Yes, two new Current Procedural Terminology (CPT) codes added in 2016 by the American Medical Association allow you to bill for clinical staff members’ time spent with a patient above and beyond what is considered to be the usual amount of time. …
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UCA Webinar: Taking Measure of Patient Satisfaction
The key to gaining patient loyalty is ensuring patient satisfaction. But how do you measure that—outside of noticing that you don’t have many repeat visits? One of the earliest and best-regarded entrants into the urgent care market, David Stern, MD will suggest approaches in Measuring Patient Satisfaction: Keeping It Simple, a one-hour webinar to be hosted by the Urgent Care Association (UCA) February 18 at 1 p.m., Central. Dr. Stern is CEO of Practice Velocity, …
Read More2016 Current Procedural Terminology Changes Pertinent to Urgent Care
Evaluation and Management There were two revisions and two additions to the “Evaluation and Management” section. Add-on codes 99354, “Prolonged evaluation and management or psychotherapy service(s) (beyond the typical service time of the primary procedure) in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour,” and 99355, “. . . each additional 30 minutes,” were revised to add the term psychotherapy in the description. Some good news in …
Read MoreSame or Similar Diagnoses for Follow-Up Visits
Q. Is there a global period for the diagnosis used for follow-up on an evaluation and management (E/M) code when there is not a change in the chief symptom? We had a patient with a skin irritation for which the provider prescribed a hydrocortisone cream for the diagnosis of “dermatitis, unspecified” (L30.9). The provider instructed the patient to return in 1 week if the condition did not clear up. The patient returned 3 days later …
Read MoreTravel Immunizations
Q. What is the best way to code for and bill patients who come in because they are planning to travel out of the country and need to know what immunizations they should have before traveling? We advise them on preventive measures to take in relation to where they are traveling, provide literature if appropriate, and even try to find health-care facilities close to where they will be staying while abroad. I know we can …
Read MoreCoding Conundrum: E/M with a Procedure
Q.We always get denials for the E/M code in addition to a procedure. Are we doing something wrong? A.Denials for payment for an E/M in addition to a procedure may stem from several sources: Missing modifier If you perform a procedure with a 0- or 10-day global period and you perform and document a separate E/M on the same day, always attach modifier -25 to the E/M to reduce denials and costs of rebilling. Use …
Read MoreS Codes (S9088 and S9083) in Urgent Care
The urgent care practitioner may not live by coding alone, but proper reimbursement depends on it. To that end, Dr. David Stern, who is in great demand as a speaker and consultant on coding in urgent care, will offer answers to commonly asked questions in every issue of JUCM. In this issue, he delves into the sometimes confusing realm of the S codes. Q.What is an S code? A.S codes are a set of Healthcare …
Read MoreEvaluation and Management: Coding Details
Q.Why is the (E/M) code important in urgent care? A.Because the majority of urgent care revenue is derived from E/M codes (mostly codes 99210-99215), accurate E/M coding is the most important coding variable in urgent care revenue. Inaccurate E/M coding is, also, the number-one reason that urgent care centers run into compliance issues with payors and regulatory agencies. Q.I see that the Centers for Medicare and Medicaid Services (CMS) lists two sets of guidelines, 1995 …
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