Coding and Documentation
Answers to Your Questions
Fam Pract Manag. 1999 Jul-Aug;6(7):12.
- Payment for extra time
- Fine-needle aspiration
- Preadmission OB services
- Sports physicals, revisited
- Multiple same-day tests
- Suture removal
- A summertime vaccination
Payment for extra time
I spent 80 minutes with an established patient today. The visit would otherwise be coded as a 99214, but is there some way to capture the extra time involved?
Yes. Use the prolonged services codes 99354 (for the first hour) as well as the appropriate evaluation and management (E/M) code — in this case, 99214.
What code should I use for fine-needle aspiration?
According to CPT, code 88170 is for “Fine-needle aspiration with or without preparation of smears; superficial tissue (e.g., thyroid, breast, prostate).”
Preadmission OB services
How do I bill for obstetric services provided in the hospital — such as evaluating a patient with preterm contractions or hypertension, or ruling out rupture of membranes — when the evaluation doesn't lead to admission? By my reading of the global maternity care codes, these services should be billed separately. Am I right? If so, how do I code these visits?
I concur with your interpretation. In the introduction to the “Maternity Care and Delivery” section, CPT states, “For medical complications of pregnancy (e.g., cardiac problems, neurological problems, diabetes, hypertension, toxemia, hyperemesis, preterm labor, premature rupture of membranes), see services in the Medicine and Evaluation and Management Services section[s].” Your examples seem to be “medical complications of pregnancy” such that, as you noted, they should be coded and billed separately using the appropriate E/M or medicine codes.
Sports physicals, revisited
You stated previously (January 1999) that if a sports physical meets the criteria for a comprehensive history and exam, the preventive services code should be used. If the documentation does not meet the comprehensive criteria, you say “use the appropriate office visit code.”
I feel this is incorrect since the sports physical is still a screening physical — many of which are done on abbreviated forms. The 99201-99215 codes are problem-oriented and would be incorrect for any type of screening physical (employment, sports, camp, prison, etc.) as well as “annual physicals.” In our practice, we use a preventive service code, appropriate to age, and a -52 modifier when the visit is an abbreviated screening visit.
Our answer reflects the advice given in the AMA's CPT Companion: Frequently Asked Questions about CPT Coding, page 24. Since the AMA owns and maintains CPT, we consider this to be very reliable information.
Multiple same-day tests
What code should I use to indicate that I repeated a laboratory test on the same date of service (for example, to get a series of readings about one aspect of a patient's condition) so that payers won't think they're duplicates?
Both CPT and HCPCS provide modifiers you can attach to subsequent instances of a laboratory code billed on the same date of service. CPT offers modifier -76, “repeat procedure by same physician,” and HCPCS has established modifier -QR to indicate “repeat clinical diagnostic laboratory test performed on the same day to obtain subsequent reportable test value(s) (separate specimens taken in separate encounters).”
What code should I use for in-office removal of sutures placed by another physician (for example, following treatment in the emergency department)?
There is no specific CPT code for this service. Use an office-visit code, such as 99211.
A summertime vaccination
How should I code a vaccination for Lyme disease?
Use 90665 for the vaccine itself plus 90471 for the administration.
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.”
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