CODING & DOCUMENTATION
Answers to Your Questions
Fam Pract Manag. 2001 Jul-Aug;8(7):16.
- Coding counseling
- Reimbursement for reviewing records
- Prolonged services code for hospital care
- HepB/Hib vaccine
When a patient comes in for a preventive medicine service or a regular office visit and has extensive questions about cholesterol management, diabetes, contraception, etc., we use the ICD-9 code V65.49, “Other counseling, not elsewhere classified; other specified counseling,” in addition to the other appropriate diagnosis codes for the visit. However, a coding consultant told us that V65.49 shouldn’t be used very often and shouldn’t be used to justify a higher level of visit. We feel the cognitive skills necessary for the portion of the visit devoted to counseling the patient on medical topics should be reflected in both the diagnostic and procedural codes.
You are correct that the nature of the service provided should be reflected in both the ICD-9 and CPT codes that appear on the superbill and claim form. Payers may use the diagnosis codes to confirm that the service indicated by the procedure code was appropriate and reimbursable. That said, diagnosis code V65.49 probably won’t help to justify the level of service you’ve described because it is a nonspecific code, and payers prefer that nonspecific codes be used only when more specific codes are unavailable (see “ICD-9 Coding: Every Digit Counts,” FPM, October 2000, page 16).
In the situation you described, you’d be better served to use a more specific diagnosis code, if possible. For example, for contraception counseling, you can submit codes in the range of V25.40–V25.49, which includes specific codes for contraceptive pills (V25.41), intrauterine contraceptive devices (V25.42) and implantable subdermal contraceptives (V25.43). Or, if the counseling for cholesterol and diabetes is essentially dietary in nature, you can use code V65.3, “Dietary surveillance and counseling.”
Of course, the CPT code you choose for a problem-oriented evaluation and management (E/M) service (99202–99205, 99212–99215) should be based on the level of history, examination and medical decision making involved in the encounter. However, if counseling or coordination of care dominate the encounter, you may code based on the time spent with the patient.
Reimbursement for reviewing records
My wife, a family physician, sometimes spends hours reviewing old records for a single patient, taking notes and generating a summary page. I bet her that there is a billing code she can use for this, but she insists it is “proper and complete care” and there are no separate codes for this. Who wins the bet?
Your wife wins. According to the CPT manual, the “amount and/or complexity of medical records, diagnostic tests and/or other information that must be obtained, reviewed and analyzed,” is generally considered to be part of the medical decision making associated with E/M services and is not separately reportable.
Prolonged services code for hospital care
I understand that when patients initially seen in the office require hospital admission the correct E/M code should be an initial hospital care code, not an outpatient code. However, if a patient required prolonged care in the office (e.g., to control blood pressure) before the decision to admit was made, can CPT code 99354 be submitted in addition to the initial hospital care code?
You can submit a prolonged services code with initial hospital care codes (99221–99223), but you should use 99356 or 99357 instead of 99354. The prolonged services code 99354 can be used in conjunction with office or outpatient services codes (99201–99215), office or outpatient consultation codes (99241–99245), nursing facility services codes (99301–99316), domiciliary services codes (99321–99333) and home services codes (99341–99350).
What is the CPT code for the combination vaccine for HepB and Hib?
The proper CPT code for the vaccine itself is 90748, “Hepatitis B and Hemophilus influenza b vaccine (HepB-Hib), for intramuscular use.” You should also submit CPT code 90471 for the administration of the vaccine.
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.
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. Because CPT and ICD-9 codes change annually, you should refer to the current CPT and ICD-9 manuals and the “Documentation Guidelines for Evaluation and Management Services” for the most detailed and up-to-date information.
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Send questions and comments to email@example.com, 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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