Coding & Documentation
Answers to Your Questions
Covered in FPM Quiz
CPT code for tick removal
Q What is the proper procedure code for removing a tick, intact, from a patient's scalp?
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A The removal of an outside element (e.g., tick, ring, splinter) that does not require incision is considered part of the management of the problem; therefore, you should simply use an appropriate evaluation and management (E/M) code for the encounter.
Documentation for review of systems
Q When the documentation states "all others negative" in the review of systems (ROS) portion of the visit, does that count as a bullet?
A No. However, a note indicating all other systems are negative, in combination with individually documented positive or pertinent negative responses, is permissible to document a "complete" ROS, according to both the 1995 and 1997 versions of Medicare's "Documentation Guidelines for Evaluation and Management Services." Otherwise, a complete ROS requires that at least 10 systems be individually documented.
99283 for an urgent care visit
Q Can we use 99283 to bill for an urgent care visit?
A It depends on where the visit occurs. Codes 99281-99285 cover E/M services provided in an emergency department, so if the visit occurs in an emergency department, then 99283 would be appropriate, assuming that you met the key components for that code and that the patient is registered as an emergency department patient. If the visit occurs in your office or another outpatient setting other than the emergency department, you should use the appropriate office visit code. You may also be able to code one of the special services codes in the 99050-99058 series (e.g., 99058, "Office services provided on an emergency basis").
Prothrombin time
Q What is the appropriate code for a waived test of a patient's prothrombin time? I found both 85610 and 85611 on the CMS Web site but couldn't tell the difference. Also, does the HCPCS -QW modifier for CLIA waived tests need to be added?
A Code 85610 is for "Prothrombin time" and should be used for monitoring prothrombin times for patients on anticoagulation therapy. Code 85611 is for "Prothrombin time; substitution, plasma fractions, each." This code describes a test that is given to evaluate the cause of a prolonged prothrombin time. I find code 85610 on the CLIA waived tests listing but not 85611. Therefore, you would append the -QW to 85610.
Billing for arthrocentesis
Q When performing an arthrocentesis and steroid injection, can I bill for both the aspiration and the injection?
A If you do an aspiration and injection of the same joint on the same date, you should only code the service once (e.g., 20600, "Arthrocentesis, aspiration and/or injection; small joint or bursa (e.g., fingers, toes)"). If the aspiration and injection are done on different joints, then you should code each service separately. If this means you have to submit the same code two times, you may need to add modifier -59, "Distinct procedural service," to the second instance of the code to indicate that the service was done on different joints on the same date.
Billing for cervical biopsy
Q Would you recommend holding the billing for a cervical biopsy until the results are known?
A No. Selecting the appropriate CPT code for cervical biopsy does not depend on the biopsy results. When billing for the cervical biopsy, select the diagnosis code that reflects the results of the abnormal Pap smear that prompted the biopsy rather than the results of the biopsy itself. The diagnosis codes in the 795.0x series describe abnormal Pap smear results that may prompt a cervical biopsy. The codes in the 622.1x series describe histology results and are used to denote biopsy results.
Sports physicals for students
Q What is the appropriate CPT code for sports physicals for high school students?
A If the
physical involves a comprehensive history and exam, use the age-appropriate
preventive services code. Otherwise, use the appropriate office visit code.
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.
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