CODING & DOCUMENTATION
Answers to Your Questions
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Fam Pract Manag. 2001 Jun;8(6):21.
- Telephone care reimbursement
- Lead-toxicity screening
- Inpatient admission
- Emergencies in the office
- ICD-9 code for fibromyalgia
- CLIA-waived strep test
Telephone care reimbursement
Some patients frequently call the office requesting to speak with the physician and often won’t speak with the nursing staff or receptionist about what is seemingly a minimal problem. I’ve found CPT codes for telephone case management services (99371-99373), but I’ve noticed that Medicare does not reimburse for these services. In my experience, if Medicare won’t reimburse for a service, it’s unlikely any insurance carrier will. Is there a way to charge the patient for the phone calls?
There is no way to separately charge Medicare patients for phone calls, since Medicare considers payment for these calls to be bundled in with the payments it makes for evaluation and management (E/M) services. Don’t assume that insurers will not reimburse you for telephone case management services provided to non-Medicare patients. Some may, in fact, provide reimbursement for codes 99371-99373. Check with the major insurers you work with regarding their policies.
Which ICD-9 and CPT codes should be used for lead-toxicity screening? Which codes should be used for discussing the results with the patient in the office?
The most appropriate primary diagnosis code in either case appears to be V82.5, “Special screening for other conditions, chemical poisoning and other contamination,” which includes screening for heavy metal poisoning. You may also want to use V15.86, “Exposure to lead,” as a secondary diagnosis, as appropriate. Assuming the lead screen is a laboratory test, the most appropriate CPT code is 83015, “Heavy metal (arsenic, barium, beryllium, bismuth, antimony, mercury); screen.” Code the office visit for discussing the results using the appropriate office visit code (99201-99215).
Our auditor says that when we see a patient in the clinic and admit him or her to the hospital on the same day, we should not be charging for initial hospital care (99221-99223), since the service was rendered in our office, not the hospital. She said we should be charging for a high-level office visit and, when we see the patient the following day in the hospital, initial hospital care. Is this correct?
This is correct if you do not go to the hospital to do the admission or otherwise see the patient in the hospital on the date of admission. According to CPT, the initial hospital care codes (99221-99223) are used to report "the first hospital inpatient encounter with the patient by the admitting physician." However, when you see a patient in the clinic and admit him or her to the hospital on the same day and you either go to the hospital to do the admission or see the patient in the hospital on the date of admission, you should submit an initial hospital care code rather than an office or outpatient visit code (99201-99215). In this case, for services provided to the patient in the hospital on the following day, you should submit subsequent hospital care codes (99231-99233). As CPT states, "When the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service … all E/M 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.
Emergencies in the office
Is the correct use of 99058, “Office services provided on an emergency basis,” to add it to the customary office visit codes (99201-99215)? Can an “after-hours” code also be used?
According to CPT, 99058, like the other codes in the range 99000 through 99090, represents “an adjunct to the basic services rendered,” so it should be billed in addition to the code for the base service rendered, as you suggested. The after-hours codes also fall into this category. Nothing in CPT prohibits coding both an after-hours code (e.g., 99050) and 99058 in addition to an office visit in the case of an office visit involving services provided on an emergency basis after office hours.
ICD-9 code for fibromyalgia
What is the diagnosis code for fibromyalgia?
According to ICD-9, it is 729.1, “Other disorders of soft tissues, Myalgia and myositis, unspecified.”
CLIA-waived strep test
What is the proper CPT code for a CLIA-waived strep-A procedure performed in the office?
Code 87880, “Infectious agent detection by immunoassay with direct optical observation; Streptococcus, group A,” should be used for all immunologically based, commercial testing kits for Streptococcus group A that link the interpretation to a visual reaction (observed by the naked eye).
If this does not accurately reflect the strep-A procedure to which you are referring, consider one of the following codes as an alternative: 87430, 87650, 87651, 87652, 86403 or 87081. When billing Medicare for a CLIA-waived test, you will also need to add modifier -QW, “CLIA-waived test,” to the CPT code (e.g., 87880-QW).
Kent Moore is the AAFP’s manager for health care financing and delivery systems and is a contributing editor to FPM. Conflicts of interest: none reported.
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Copyright © 2001 by the American Academy of Family Physicians.
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