CODING & DOCUMENTATION
Answers to Your Questions
Fam Pract Manag. 2001 Feb;8(2):14.
- Pneumococcal vaccinations and flu shots
- Radiology consults
- Day two of a three-day observation stay
- Prolonged services or critical care maximums
- “Significant, separately identifiable” E/M service
Pneumococcal vaccinations and flu shots
What’s the correct way to code pneumococcal vaccinations and flu shots given by a nurse?
The answer depends on several factors. My answer assumes that this is the only service provided and that there is no evaluation and management (E/M) component involved.
The CPT codes for the pneumococcal vaccine are 90669 and 90732. There are four codes for flu vaccine: 90657, 90658, 90659 and 90660. The appropriate vaccine administration code should also be reported. There are two administration codes to be used for most non-Medicare patients: 90471 for administering one vaccine and 90472 for administering each additional vaccine. So, for example, if a patient received both the flu and pneumococcal vaccines at the same encounter, the practice would code the two vaccines (e.g., 90732 and 90658) plus 90471 and 90472.
Medicare has different codes for vaccine administration, so for Medicare patients the practice should use G0008, “Administration of influenza virus vaccine,” and G0009, “Administration of pneumococcal vaccine,” in addition to the appropriate codes for the vaccines themselves.
When we send X-ray films done in a family practice office to a radiologist for a second opinion after having billed the insurance for a global charge, what code should the radiologist use to be reimbursed?
Based on the information you’ve provided, it seems the radiologist could use CPT code 76140 or, in the case of a Medicare patient, use the code for the radiological exam with a –26 modifier attached. In either case, the presumption is that the X-ray consult is done independently of any E/M service provided to the patient by the radiologist.
According to CPT, when, for example, Doctor A at one location sends a radiograph taken at that location to Doctor B at another location and asks Doctor B to offer his opinion on the radiograph, and Doctor B writes a formal report on his interpretation of the radiograph and sends a copy of this report to Doctor A, Doctor B should use code 76140. This code is not intended to be used by physicians within the same institution to reread radiographs taken at that institution.
Day two of a three-day observation stay
What code should I use for the second day of a three-day observation stay?
From a CPT perspective, you should use code 99499, “Unlisted evaluation and management service.” The other observation care codes in CPT describe initial observation care (99218–99220), observation care discharge (99217), and observation care involving admission and discharge on the same date (99234–99236). None of these apply to the second day of a three-day stay in observation.
Prolonged services or critical care maximums
Is there a maximum amount of time that can be attributed to prolonged services or critical care? CPT includes an example that involves reporting the additional 30 minutes of either prolonged services or critical care up to four times. Is this just an example, or is it actually the maximum reportable?
From a CPT perspective, the examples given for critical care and prolonged services are just that: examples. That is, according to CPT, there is no maximum, other than the hours available in the day, to the amount of prolonged services or critical care that can be reported on a given date of service.
“Significant, separately identifiable” E/M service
If a patient comes in for a biopsy of a skin lesion and while he’s here has questions or concerns about hypertension and elevated triglycerides that we address, can we charge the biopsy code plus an office visit code?
Yes. If the work otherwise associated with an E/M service, such as 99212, is done to address his concerns about hypertension and elevated triglycerides, this can be coded as a significant, separately identifiable E/M service done at the same encounter as the biopsy of the skin lesion. In this case, you would add modifier –25, “Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service,” to the office visit code.
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.”
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Send questions and comments to firstname.lastname@example.org, or add your comments below. While this department attempts to provide accurate information, some payers may not accept the advice given. Refer to the current CPT and ICD-10 coding manuals and payer policies.
Copyright © 2001 by the American Academy of Family Physicians.
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