Coding and Documentation
Answers to Your Questions
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Fam Pract Manag. 1999 Apr;6(4):12.
- Coding a combination vaccine administration
- Billing for preoperative physicals
- Disability evaluations and regular office visits
- Payment for family-member visits?
- Coding for routine diabetes follow-up
- Coding Foley catheter placement
Coding a combination vaccine administration
How should I code administration of a combination hepatitis B and Hemophilus influenza b (HepB-Hib) vaccine?
Use code 90748 for the vaccine plus 90471 for the administration.
Billing for preoperative physicals
How should I bill preoperative physicals that I do for surgeons? Can Medicare deny these charges (i.e., lump payment for them with the surgeon's global fee)?
When, at the surgeon's request, a family physician performs a preoperative evaluation of a patient's fitness for surgery and reports back to the surgeon, the family physician may bill the service as a consultation (codes 99241-99245 if performed in the office). According to CPT, a service qualifies as a consultation when it's “provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source.” In this case, the surgeon is requesting the family physician's advice about the patient's fitness for surgery. Note that, according to CPT, you need to document in the patient's record both the request and the need for consultation. Plus, you must document and communicate to the surgeon your opinion and any services you order or perform.
Medicare shouldn't deny payment for a consultation like this provided by a family physician. HCFA has stated that it will recognize such services for separate reimbursement.
Disability evaluations and regular office visits
Can I code 99455 for a work-related or medical disability evaluation as well as a regular office-visit code (such as 99213) for the same encounter, if it's appropriate?
Yes. Code 99455 is one of three used to report evaluations required for life or disability insurance certificates. According to CPT, if you perform other evaluation and management or procedural services on the same day, you may report codes for those services along with the insurance-evaluation code.
Payment for family-member visits?
A patient's family member came in for the patient's visit without the patient but with a list of the patient's blood pressure readings. The family member wanted to discuss the patient's condition and medication changes. May I bill Medicare for a visit by the patient even though the patient wasn't physically present?
I would advise against it. Medicare generally assumes that a service billed in a patient's name involves the patient's presence. But you may want to consider billing the family's insurance, since this visit could be construed as a service to the family member as much as to the Medicare patient.
Coding for routine diabetes follow-up
What diagnosis code should I use for a return visit by a patient with diabetes when the visit is related to health promotion, prevention and routine follow-up?
The correct code would be 250.00 or 250.01, depending on whether the diabetes was type 2 or type 1, respectively. These are the codes for diabetes mellitus that is under control and without complications. Your question suggests that you would like to use a code for something other than diabetes (such as a V code). But if diabetes is the condition for which the patient is being seen for follow-up, then a V code would probably be inappropriate.
Coding Foley catheter placement
What code should I use for placement of a Foley catheter for urine collection?
There is an HCPCS code, G0002, for “Office procedure, insertion of temporary indwelling catheter, Foley type (separate procedure).” If your payer doesn't accept HCPCS codes, use an office-visit code (if the service took place in the office) or the code for unlisted urinary procedures (53899).
Editor's note: While this department represents our best efforts to provide accurate information and useful advice, we can't guarantee that third-party payers will accept the coding and documentation recommended. For more detailed information, refer to the current CPT manual and the “Documentation Guidelines for Evaluation and Management Services.”
Kent Moore is the AAFP's manager for reimbursement issues and a contributing editor to Family Practice Management.
Copyright © 1999 by the American Academy of Family Physicians.
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