Coding & Documentation

Answers to Your Questions

Kent J. Moore

Covered in FPM Quiz

Appropriate use of 99050

Q Our office's posted hours are Monday through Friday, but we make it clear to patients that the office is also open on Saturday mornings for urgent care from 8:30 to noon. Is it appropriate to submit CPT code 99050, "Services requested after posted office hours in addition to basic service,” for care provided on Saturday mornings? Does it make a difference if we are providing a mixture of urgent visits and routine visits then?

A It would not be appropriate to submit 99050 for services you provide on Saturday mornings. Since your office is regularly open and staffed on Saturday mornings from 8:30 to noon and you've shared this information with your patients, these hours have become part of your "posted” office hours. The same is true if you have posted office hours in the evening (e.g., between 5 p.m. and 8 p.m.). Whether you provide a mixture of same-day urgent visits and routine visits is irrelevant to the use of 99050.

Biopsy vs. excision

Q What is the difference between "biopsy” and "excision,” according to CPT? For example, if I removed an entire lesion and sent it to pathology, would that be considered a "biopsy” or an "excision?”

A "Excision” is defined by CPT as "full-thickness (through the dermis) removal of a lesion, including margins, and includes simple (nonlayered) closure when performed.” It also includes local anesthesia. CPT notes that during certain integumentary procedures, such as excision, the removed tissue is often sent to pathology: "The obtaining of tissue for pathology during the course of these procedures is a routine component of such procedures. This obtaining of tissue is not considered a separate biopsy procedure and is not separately reported.” CPT defines "biopsy” as follows: "The use of a biopsy procedure code (e.g., 11100, 11101) indicates that the procedure to obtain tissue for pathologic examination was performed independently, or was unrelated or distinct from other procedures/services provided at that time.” So, generally, if the entire lesion is removed, as in your example, the shave (11300-11313) or excision (11400-11646) codes should be used, even if the lesion is subsequently sent to pathology. If only a portion of the skin lesion is removed specifically for the purposes of determining its pathology, you should use a biopsy code (11100 and 11101).

Multiple reevaluations and therapies in one visit

Q What code(s) should I submit for an office visit that requires multiple reevaluations and therapies? What if a patient presents with nausea, vomiting and mild dehydration, and I spend three hours evaluating, treating (with IV fluids and antiemetics) and reevaluating the patient?

A You should submit an office-visit code that reflects the total history, exam and medical decision making required for all of the care you provided (in your case, three hours). In some cases where a visit involves multiple reevaluations and treatments and extended face-to-face time, it may also be appropriate to submit prolonged services codes (99354-99355). However, this may not be true in your case. CPT states that the prolonged services codes may not be submitted with the codes you would probably be submitting for the intravenous fluid administration you provided: 90780, "Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour,” and 90781, "each additional hour, up to eight (8) hours.” When reporting time-based codes such as 99354-99355, the physician must document the time spent face-to-face with the patient. The rest of the time the patient spends in the office or with auxiliary personnel only is not counted toward the time required by the codes.

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, CCS-P; 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.