Coding & Documentation

Answers to Your Questions

Kent J. Moore

Covered in FPM Quiz

Coding a preoperative visit

QWhat CPT code should be used for proper coding of a preoperative visit, and does the place of service (office vs. hospital) make a difference?

AFamily physicians do most of these services at the request of a surgeon, who is usually seeking the family physician's opinion on whether the patient is fit for surgery. If you document this request in the patient's medical record (e.g., "Ms. Jones seen at the request of Dr. Smith, who is requesting preoperative clearance due to X") and provide a written report to the requesting surgeon, you should be able to report these preoperative visits using a consultation code. If the service is done in the office, use an office consultation code (99241-99245); if it is provided in the hospital, use an initial inpatient consultation code (99251-99255). In either case, choose the level of service based on the level of history, exam and medical decision making involved, since all three key components must be met to code a given level of consultation. [For more information, see "Medicare Clarifies Preoperative Services Reimbursement Policy," FPM, September 2001, page 16.]

Coding group medical visits

QWhat code(s) should I submit for group medical visits?

AThe CPT Editorial Panel advises coding group medical visits using 99499, "Unlisted evaluation and management (E/M) service," since no specific CPT codes exist for this service. Some practices that use group medical visits have coded these encounters with traditional office visit codes (99201-99215). However, doing so may be considered fraudulent by Medicare and other payers, since these codes have traditionally described individual encounters. "Group medical visits" are distinct from other kinds of group encounters referenced in CPT, such as group psychotherapy (90846-90857) and group preventive medicine counseling (99411-99412).

CPT code for the rapid flu test

QWhat CPT code should I submit for the rapid flu test?

AIf you are billing for the procedure in which you take a respiratory sample (e.g., throat or nasal swab, nasal aspirate or sputum) and do the rapid test, you should submit 87804, "Infectious agent antigen detection by immunoassay with direct optical observation; Influenza." This is a new code that went into effect Jan. 1, 2002. However, if you are using some other source (e.g., culture material) or technique, which would not generally be considered a "rapid" flu test, you should submit a different code, such as 87400, "Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; Influenza, A or B, each."

ICD-9 code for sports physicals

QWhat ICD-9 code should be used for sports physicals?

AV70.3, "Other medical examination for administrative purposes," includes general medical examinations for sports competition.

Manipulation & E/M

QIf a patient presents with back pain and the physician does an evaluation and an osteopathic manipulative treatment (OMT), can he or she code for the OMT and an E/M service?

A Yes. In the notes preceding the OMT codes (98925-98929), CPT states: "[E/M] services may be reported separately, using the modifier -25, if the patient's condition requires a significant, separately identifiable E/M service, above and beyond the usual preservice and postservice work associated with the procedure. The E/M service may be caused or prompted by the same symptoms or condition for which the OMT service was provided. As such, different diagnoses are not required for the reporting of the OMT and E/M service on the same date."

Editor's note: While this department attempts to provide accurate information and useful advice, third-party payers may not accept the coding and documentation recommended. 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.

Kent Moore is the AAFP's manager for health care financing and delivery systems and is a contributing editor to Family Practice Management. Conflicts of interest: none reported. These questions and answers were reviewed by members of the FPM Coding & Documentation Review Panel, which includes: Robert H. Bosl, MD, FAAFP; Marie Felger, CPC; Thomas A. Felger, MD, DABFP, CMCM; David Filipi, MD, MBA, and the Coding and Compliance Department of Physicians Clinic; Lynn Handy, CPC, LPN; Emily Hill, PA-C; Joy Newby, LPN, CPC; P. Lynn Sallings, CPC; and Susan Welsh, CPC.