Fam Pract Manag. 2000 Feb;7(2):19.
- Preventive medicine services revisited
- Bone mass measurements
- ICD-9 code for dyspnea
- A discharge code for a deceased nursing facility patient?
- Retirement community visits
Preventive medicine services revisited
Since I stated in the October 1999 issue that it was inappropriate from a CPT perspective to use a -52, “Reduced Services,” modifier with a preventive medicine services code to code an abbreviated screening visit, such as a sports physical, I have received numerous inquiries asking for further explanation. Here it is: According to CPT, “The ‘comprehensive’ examination of the Preventive Medicine Services codes 99381-99397 is not synonymous with the ‘comprehensive’ examination required in Evaluation and Management codes 99201-99350.” CPT does not specify the requirements for a comprehensive exam provided as part of a preventive medicine service, but does say, “The extent and focus of the services will largely depend on the age of the patient.” Consequently, each preventive medicine services code is, in a sense, elastic enough to encompass a range of services such that a reduced services modifier does not make sense in this context. I consulted with the AMA's Department of Coding and Nomenclature, which develops CPT, and they confirmed this interpretation.
Bone mass measurements
How should I code for bone mass measurements?
There appear to be at least four codes that relate to bone density studies:
76070 Computerized tomography bone mineral density study, one or more sites,
76075 Dual energy X-ray absorptiometry (DEXA), bone density study, one or more sites; axial skeleton (e.g., hips, pelvis, spine),
76076 Dual energy X-ray absorptiometry (DEXA), bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel),
76977 Ultrasound bone density measurement and interpretation, peripheral site(s), any method.
ICD-9 code for dyspnea
What is the diagnosis code for dyspnea on exertion?
Try one of the codes in the 786.0 section, “Dyspnea and respiratory abnormalities.” Note that you'll need a fifth digit to identify the correct code at its highest level of specificity.
A discharge code for a deceased nursing facility patient?
A nursing home patient whom I had seen in the hospital, discharged and admitted to the nursing home, died recently. The nursing home and the state of Nevada allow a registered nurse to pronounce the patient dead, then notify me later. I'm required to come along in a timely fashion and do a “discharge” summary as well as sign the death certificate. Can I bill a nursing facility discharge for this service?
I do not believe that the nursing facility discharge codes in CPT (i.e., 99315 and 99316) were intended to cover this situation. According to CPT, these codes “include, as appropriate, final examination of the patient, discussion of the nursing facility stay,” as well as instructions for continuing care and preparation of prescriptions and referral forms. In other words, CPT seems to anticipate a live patient. I would advise against billing one of these codes in your situation, especially when Medicare patients are involved. From a strict coding perspective, I believe you are left with using either 99080, “Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form” or an unlisted services code, such as 99199.
Retirement community visits
I see patients in a retirement community that includes independent living, assisted living, and traditional nursing home settings on the same campus. Am I correct in coding visits with patients in assisted living quarters as “domiciliary, rest home or custodial care?” How should I code visits with independent living residents I see in the on-site clinic? Should I use the regular office visit codes, a home visit code or an alternative? Finally, when I see the independent living folks in their apartments, can I then code a home visit?
I believe you are correct in coding visits with assisted living residents as “domiciliary or rest home” visits (99321–99323 or 99331–99333). According to CPT, these codes are for E/M services in “a facility which provides room, board, and other personal assistance services, generally on a long-term basis. The facility's services do not include a medical component.” An assisted living facility would seem to fit that description.
Regarding independent living patients seen in the on-site clinic, I would probably use a code in the 99201–99215 series, which covers services in the physician's office “or in an outpatient or other ambulatory facility.” For those seen in their apartments, I believe you can code a home visit (99341–99345 and 99347–99350). The home services codes are for services provided “in a private residence,” and the independent living apartments seem to fit that definition.
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