CODING & DOCUMENTATION
Answers to Your Questions
Fam Pract Manag. 2004 Apr;11(4):23.
- Coding translator time
- Blood-pressure checks
- Tracheostomy tube
- Patient representative
- Cerumen removal
- Office spirometry
- ICD-9 “omit code”
Coding translator time
Is there any way to capture the extra time spent with a patient in the office when a translator is involved?
The only way to account for this extra time is to submit one of the prolonged services codes (99354-99355), which requires that the face-to-face time spent with the patient extend at least 30 minutes beyond the typical time associated with the appropriate CPT service. Note that Medicare and most other payers will not pay for the services of the translator even if they are willing to pay for the extra visit time associated with using a translator.
Is it appropriate to submit 99211 for a blood-pressure check performed at the same visit as a blood draw?
Since there is no separate CPT code for a blood-pressure check, CPT anticipates that such checks will be coded as a 99211 as long as the blood-pressure check is otherwise medically necessary, involves some evaluation and management of the patient and is not done as part of another E/M or other service. For example, if a physician tells a patient with hypertension to return to the office every six months for a blood-pressure check, 99211 should be used because the blood-pressure check is medically necessary to evaluate and manage the patient’s hypertension. On the other hand, if every patient who comes in for a blood draw is automatically given a blood-pressure check without regard to each patient’s individual medical concerns, 99211 would not be appropriate because the blood-pressure check may be considered screening – no medical reason exists for the service and no management of the patient occurs.
Note that the blood draw for the lab work should be coded separately using 36415, “Collection of venous blood by venipuncture” (assuming the blood was drawn using routine venipuncture) or G0001, “Routine venipuncture for collection of specimen(s)” (for Medicare beneficiaries). And if the blood draw was the only service received, 99211 would not be appropriate.
Is there a CPT code for changing a tracheostomy tube, which is something I often do in a nursing facility setting? Someone suggested 31502, but that does not seem correct.
There is no specific code for this service. Code 31502 should not be used for a simple tracheostomy tube change. You can try submitting 31899, “Unlisted procedure, trachea, bronchi.” However, an E/M code (e.g., 99311 in a nursing facility setting) would probably be more appropriate, since most payers would likely view a simple tracheostomy tube change as a service included in the evaluation and management provided to the patient and, thus, not separately reportable.
A father had a visit with me to discuss his 16-year-old daughter’s health problem in her absence. I think I should treat this as a service to the father rather than the daughter by submitting the following codes: V65.19, “Other person consulting on behalf of another person (advice or treatment for nonattending third party)” for the primary diagnosis, the daughter’s problem for the secondary diagnosis and a CPT consultation code. Is this correct?
Partly. I agree that you should bill this as a service to the father (see also “Payment for family-member visits?” April 1999, page 12) and that the primary diagnosis in this case should be V65.19, as you suggested, or V61.49, for people encountering health services to discuss the care of a sick person in their family. However, I would caution against using the daughter’s health problem as a secondary diagnosis, given that the visit will be billed as a service to the father. Depending on the health problem, the claim may be rejected due to a disconnect between the secondary diagnosis and patient gender or you may inaccurately attach a diagnosis to the father’s claim history that could negatively impact him (e.g., if the secondary diagnosis is related to mental health or HIV). As for the CPT code, an office-visit code based on time may be appropriate if at least half the encounter is consumed by counseling and coordination of care, as it likely would be in this case. Alternatively, you could submit a confirmatory consultation code (99271-99275) if your advice or opinion is being sought, regardless of whether the consultation is initiated by the patient or the family.
If a patient who presents with otitis and conjunctivitis also has cerumen impaction and I irrigate the ear, should I attach modifier -59 to the irrigation (as it states in the separate procedure guidelines in the Surgery Guidelines section of the CPT manual) or modifier -25 to the E/M code? What if the nurse irrigates the ear instead of me?
You should attach modifier -25 to whatever E/M code you submit and leave the code for the cerumen removal (69210) unmodified, regardless of whether you or the nurse performed the removal. (This assumes the nurse’s service was incident to yours or was otherwise billable under your name.)
The separate procedure guidelines generally apply when one procedure that is designated as a “separate procedure” in CPT is done with another procedure, rather than with an E/M service as in your situation. If the designated separate procedure is an integral part of the other procedure that is done, the separate procedure is not separately reportable. However, if the separate procedure is done independently or otherwise unrelated to the other procedure done at the same session, the separate procedure may be coded separately with modifier -59 attached. For example, if a physician removes the impacted cerumen in an ear to do a tympanostomy (69433) on the same ear, the cerumen removal would probably not be separately reportable. However, if a physician performs cerumen removal on one ear and a tympanostomy on the other, both codes could be submitted with modifier -59 attached to the cerumen-removal code to indicate that it was a “distinct procedural service” done at a different anatomical site from the tympanostomy.
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What code(s) should I submit for office spirometry?
You should submit 94010, “Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation.” If the spirometry is administered before and after administration of a bronchodilator, you should submit 94060, “Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator (aerosol or parenteral).” Although there are other CPT codes for spirometry, such as 94620, “Pulmonary stress testing; simple (e.g., prolonged exercise test for bronchospasm with pre- and postspirometry),” and 94070, “Prolonged postexposure evaluation of bronchospasm with multiple spirometric determinations after antigen, cold air, methacholine or other chemical agent, with subsequent spirometrics,” codes 94010 or 94060 will be the appropriate codes to use in most cases.
ICD-9 “omit code”
When I looked up the term “innocent heart murmurs” in the ICD-9 manual, it stated, “omit code.” What does that mean?
According to ICD-9, “omit code” is used to instruct the coder that no code is to be assigned. When you find this instruction next to a term in the alphabetic index to diseases in ICD-9, you should not use that medical term as a diagnosis.
Kent Moore is the AAFP’s manager for health care financing and delivery systems and is a contributing editor to Family Practice Management. 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.
Conflicts of interest: none reported.
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.
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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 © 2004 by the American Academy of Family Physicians.
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