Fam Pract Manag. 2001 Jan;8(1):23.
- Well-child visits
- Teaching-physician services
- Antepartum care only
- E/M or consult?
- Nursing facility consult
- Typhoid vaccine
- ED consult
- Interpreting outside lab work
When I see a child for a well-child visit and immunizations are provided, should I submit the appropriate preventive medicine services code, the vaccine(s) and the administration code(s)?
Yes, and you may need to add modifier -25 to the preventive medicine code to indicate it was a significant, separately identifiable service.
What modifiers should we use when billing Medicare for teaching-physician services?
There are two HCPCS modifiers you may use. Modifier -GC indicates, “This service has been performed in part by a resident under the direction of a teaching physician.” Modifier -GE indicates, “This service has been performed by a resident without the presence of a teaching physician under the primary care exception.”
Antepartum care only
How many units of service are associated with 59425, “Antepartum care only; 4–6 visits?”
One, since the descriptor itself conveys that multiple visits are involved. In other words, 59425 should be submitted once rather than on each of the four to six occasions that antepartum care is provided to a patient.
E/M or consult?
If I provide a consultation and then assume management of the patient, should I continue to use consultation codes?
No. You should use other evaluation and management (E/M) codes (e.g., established patient office visits, subsequent hospital care, etc.) to describe your management of the patient.
Nursing facility consult
How should I code a preoperative consultation provided to a nursing facility patient?
You should use one of the inpatient consult codes, 99251-99255. According to CPT, these codes apply to consultations provided to “hospital inpatients, residents of nursing facilities, or patients in a partial hospital setting,” and only one initial consultation should be reported by a consultant per admission.
What code should I use for a typhoid vaccine?
Four CPT codes, 90690-90693, identify typhoid vaccine products. You should pick the code that most accurately describes the product you’re using. Remember to report the administration of the vaccine as well: 90471 would be the correct choice assuming you administered just one vaccine.
I was consulted to see a patient in the emergency department (ED) for an acute stroke and to admit him to the hospital. Upon the family’s request, the patient was transferred and admitted to another facility following my evaluation. What code should I submit? Would it be a code for ED services, consultation or something else?
The answer depends on the service you actually provided and whether you were the admitting physician at the facility to which the patient was transferred. If you provided a consultation, as defined by CPT, in the ED, then you should code one of the office or other outpatient consultation codes, 99241-99245. These codes are used to report consultations provided in the physician’s office or in an outpatient or other ambulatory facility, including an ED, according to CPT. If your service did not meet the definition of a consultation, then you should code the appropriate level of ED visit, codes 99281-99285.
It’s unclear from your question whether you admitted the patient to the facility following the transfer. If you did, you should code an initial hospital care code, 99221-99223. Here’s the CPT explanation: “When the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service (e.g., hospital emergency department …), all evaluation and management services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission.”
Interpreting outside lab work
How should I code my interpretation of lab work done outside the office?
You should add modifier -26, “Professional component,” to the appropriate laboratory CPT code to indicate the physician provided the professional component but that your office didn’t provide the technical component.
Kent Moore is the AAFP’s manager for health care financing and delivery systems and is a contributing editor to Family Practice Management.
Editor’s note: While this department represents our best efforts to provide accurate information and useful advice, we cannot 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.”
Copyright © 2001 by the American Academy of Family Physicians.
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