Coding and Documentation
Answers to Your Questions
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Fam Pract Manag. 1999 Jun;6(6):12.
- Finding the right fracture code ...
- ... and determining what it covers
- Home health care paperwork
- Coding for emergency services
- Codes for a family-member visit
- Separate same-day services
- Coding for blood glucose testing
Finding the right fracture code ...
How should I code treatment of a Colles fracture?
Use 25600 for “closed treatment of distal radial fracture (e.g., Colles or Smith type) or epiphyseal separation, with or without fracture of ulnar styloid; without manipulation.”
... and determining what it covers
Do the fracture care codes (e.g., 25600) include application and removal of a cast?
Yes. CPT guidelines indicate that the fracture care codes include the application and removal of the first cast or traction device. Subsequent replacement of a cast or traction device may require additional codes from the casting and strapping section of CPT (codes 29000-29799).
Home health care paperwork
Are there any codes to help us get paid for completing paperwork related to patients who receive home health care?
There are two care plan oversight codes, 99374 and 99375, for physician supervision of patients under the care of home health agencies. These codes cover services including “regular physician development and/or revision of care plans” and “review of subsequent reports of patient status,” which should encompass much of the paperwork you're doing.
Coding for emergency services
Our clinic is open seven days a week, and we often provide emergency services in the office. How should we code for them?
Use 99058, which covers “office services provided on an emergency basis.”
Codes for a family-member visit
For a visit from a patient's family member without the patient, FPM recently recommended that we bill the family's insurance rather than billing Medicare for a patient visit (see “Answers to Your Questions,” April 1999 ). What ICD-9 and CPT codes would be appropriate in this situation?
There is an ICD-9 code, V61.49, for people encountering health services to discuss the care of a sick person in their family. An alternative would be V65.1, which covers a person consulting on behalf of another person, seeking advice or treatment for the absent third party. Given that the diagnosis is a “V” code and that the person to whom the service is provided is asymptomatic, you probably should use a CPT code for preventive medicine counseling (e.g., 99401).
Separate same-day services
We're having problems with insurers not paying for services when we perform an unrelated procedure during an evaluation and management (E/M) visit. We're coding both services and attaching a -25 modifier to the E/M service, but the insurance companies won't recognize the modifier and only pay for the lowest-priced service. Are we coding appropriately? If so, what can we do about this situation?
Yes, you're coding appropriately. CPT is clear that when a physician provides a “significant, separately identifiable” E/M service on the same day as a procedure or other service, the E/M service should be coded with a -25 modifier and billed in addition to the other service. Note that if an insurer doesn't recognize two-digit modifiers, you can use the five-digit version, which in this case would be 09925. Typically, the diagnosis codes attached to each service will be different, but they don't have to be. (For more information, see “Should You Modify Your Use of Modifiers?” May 1999.)
Your insurers' failure to recognize CPT modifiers and to follow CPT's rules is, unfortunately, fairly common. The AMA, which owns and maintains CPT, is acutely aware of this problem. The association is working on this issue and is interested in specific examples like yours. If you would like to share your situation with the AMA, write to the AMA Department of Coding, 515 N. State St., Chicago, IL 60610.
Coding for blood glucose testing
What code should I use for blood glucose testing?
If you're using a device cleared for home monitoring by the FDA, use 82962. Otherwise, use 82947-82950.
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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