CODING & DOCUMENTATION
Answers to Your Questions
Fam Pract Manag. 2001 Sep;8(8):22.
- Coding Pap smears
- 99211 for strep screens
- Laser setup
- When a hospitalized patient dies
- Medical nutrition therapy
Coding Pap smears
How should I code for performing a Pap smear separately from an annual exam (e.g., as part of follow-up for cervical dysplasia or after loop electrosurgical excision procedure)?
I’m not aware of a CPT code for separately obtaining a Pap smear. Consequently, this would most accurately be coded using the appropriate office or outpatient visit code (99201-99215) for the encounter. The documentation guidelines for evaluation and management (E/M) services include “Pelvic examination (with or without specimen collection for smears and cultures)” in the list of exam elements for a general multisystem exam, which suggests that reimbursement for a pelvic exam is included in the reimbursement for an office visit code.
99211 for strep screens
When patients ask for a strep screen, a nurse administers it and we only charge for the strep screen itself. If the test is positive, a physician prescribes an antibiotic. What would make the nurse’s visit a separately identifiable service from the strep screen and allow a 99211 charge?
CPT considers 99211 to cover the “evaluation and management” of an established patient in the office or other outpatient setting. Although the use of 99211 does not involve any particular level of history, exam or medical decision making, it still requires some “evaluation and management” of the patient. In your example, to make the nurse’s visit a separately identifiable service, the chart would need to indicate that the nurse did something more than just administer the strep screen to the patient (e.g., noting a chief complaint or any elements of the history of present illness, taking and recording any vital signs or recording observations). Notations such as these would help establish “evaluation” of the patient. Additional notations reflecting the results of the screen and follow-up action planned (e.g., “strep screen positive; doctor prescribed antibiotic”) would help establish “management.”
What code should be submitted for laser setup: 99070, “Supplies and materials (except spectacles) provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies or materials provided),” or A4550, “Surgical trays”?
I don’t believe either of those codes would be appropriate. The setup of equipment, such as a laser, is typically included in the code for the procedure for which the equipment is used. For example, if you use a laser to destroy a benign skin lesion (17000), laser setup is considered to be part of the procedure and payment for it is included in the payment for the procedure.
When a hospitalized patient dies
I was the primary attending physician for a patient who had been in the hospital for a few days. I saw the patient in the morning and documented my visit; the patient died later that day. I went back, pronounced the patient and dictated a death summary. Can I be reimbursed for both visits? If not, which one should I submit a code for?
No, you can’t be reimbursed for both visits. According to CPT, the appropriate, time-oriented hospital discharge code (99238-99239) should be used to report “all services provided to a patient on the date of discharge, if other than the initial date of inpatient status.” This code would cover both your visit in the morning and your subsequent pronouncement of death.
A hospital discharge code can be submitted in the case of a patient death when the physician performs any of the services indicated in the guidelines for Hospital Discharge Services listed in CPT. These include a final examination of the patient, discussion of the hospital stay (even if the time spent by the physician on the date of discharge is not continuous), instructions for continuing care and preparation of discharge records, prescriptions and referral forms.
Medical nutrition therapy
Can CPT’s medical nutrition therapy codes (97802-97804) be used by a physician?
No. For medical nutrition therapy assessment and/or intervention performed by a physician, the physician should submit the appropriate E/M codes (e.g., office visit or preventive medicine services codes).
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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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 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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