October 2005 Table of Contents
Coding & Documentation
99000 for transferring labs
Q An insurance carrier recently notified us that we should not bill for 99000, "Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory," when submitting charges for lab tests. It states that this is a code the laboratory should use when billing the insurance carrier for the test. However, we are doing the data input and packaging of the specimen, which are added expenses for our office. Is the insurance company interpreting this code accurately?
A While this insurer's interpretation of the code is unusual, it is common for insurers to bundle 99000 with other services performed on the same date. Your practice can bill for the conveyance of the specimen to the laboratory in addition to the office visit at which the need for the test was identified, but many insurers will only reimburse you for the office visit code.
Change of status
Q When the hospital retroactively changes one of my patients from observation status to inpatient status, can I then submit an initial hospital care code (99221-99223) in lieu of an initial observation code (99218-99220)?
A It depends on the payer. Some payers, such as Medicare, may want you to use the code that reflects the patient's status at the time the service was rendered, regardless of the subsequent change in status by the hospital. Of course, if the patient was admitted on a date subsequent to the date of observation care, both services can be billed. For instance, let's say you admit a patient to observation on the 17th and his status is changed to inpatient on the 18th. If you provide initial observation care on the 17th and initial hospital care on the 18th, both are billable.
Counseling and vaccinations for travelers
Q I saw a patient for a 45-minute visit, and we discussed traveler's diarrhea, travel safety, malaria prevention and prophylaxis, typhoid, hepatitis, HIV, and tuberculosis. It was mostly a counseling session, but I did prescribe some antiprotozoals for malaria prophylaxis, and we administered yellow fever and typhoid vaccines. How should I code for this visit?
A Submit code 99403 for a preventive medicine counseling visit lasting approximately 45 minutes. You would also bill the vaccine administration code 90471 for one vaccine and 90472 for each additional vaccine. For example, if you administer three vaccines, you would code 90471 once and 90472 twice. (If the patient is under 8 years of age, you should submit 90465 and, when appropriate, 90466, instead.) Code separately for the actual vaccine products: 90717 for yellow fever and the appropriate code from 90690-90693 for typhoid.
Laser treatment of rosacea
Q Is there a code for laser treatment of rosacea?
A Codes 17000-17004 should be used for laser treatment of the telangiectasia that occurs with rosacea. Note that codes 17106-17108 are intended only for congenital port wine stains and hemangiomas.
Emergency care outside an ED
Q We are a small, rural health center that sees patients for regular office visits and emergent issues (the nearest hospital is 75 miles away). Which codes should we be using to code the emergency visits?
A It sounds like your site would not be considered an emergency department, according to the CPT definition: an organized hospital-based facility available 24 hours a day to provide unscheduled episodic services to patients who need immediate medical attention. So you should code 99058 for office services provided on an emergency basis. This should be billed in addition to the E/M code. If your clinic is a designated rural health center for Medicare and/or Medicaid, you may not bill the emergency office visit code as it is bundled with the other services provided in the visit.
Note that 99058 is only to be used when, in the physician's judgment, the "emergency" warrants interrupting the care of other patients. This code is not to be used for urgent care slots or work-in appointments. If prolonged services are provided, these may be billed in addition to the codes for the E/M and the emergency services. Critical care services provided for 30 minutes or more may be billed with codes 99291-99292. Medicare does not allow reimbursement of both an E/M service and critical care service code when provided at the same visit.
Coding an initial consultation
Q How should we code for an initial office consultation that takes approximately 1.5 hours?
A Choose the appropriate office or other outpatient consultation code based on the key components (history, exam and decision making) or based on time if counseling/coordination of care dominated the encounter. For instance, if your documentation of the 1.5 hours meets the criteria for a 99244, which typically includes 60 minutes of face-to-face time with the patient or family as well as a comprehensive history, comprehensive examination and medical decision making of moderate complexity, you can code the additional time using 99354. If your documentation meets the criteria for 99245, which typically includes 80 minutes of face-to-face time, you would not use an additional code because prolonged services of less than 30 minutes are not billed separately. However, CPT does allow for use of modifier -21 to report prolonged services beyond that described in the highest-level code of a category such as 99245.
Worried well" exam
Q How should you code a visit by a concerned mother for her infant when the exam turns out to be normal?
A You would use one of the usual office visit codes (i.e., 99212-99215, assuming the patient is established). The level of service would depend on the history, exam and medical decision making involved or the time involved, if counseling dominated the encounter. You could choose diagnosis code(s) based on the signs or symptoms that prompted the mother's concerns, or you could use the V code for "worried well" (i.e., V65.5, "Person with feared complaint in whom no diagnosis was made"). Even though you don't identify a problem, you can still submit an office visit code, because the encounter was prompted by perceived concerns (i.e., it was not preventive) and the work of a problem-oriented visit was done.
Billing for care plan oversight
Q We do lots of care plan oversight but have never billed for it. Are the G0180 and G0182 codes for a 30-day period?
A G0182, which is for care plan oversight of a patient under Medicare-approved hospice, is for services "within a calendar month." The same is true for code G0181, which is for care plan oversight of a patient receiving Medicare-covered home health services. Code G0180 is for physician certification of Medicare-covered home health services. It is typically reported for a single date of service on which the physician certifies the patient's home health services, rather than spanning a range of dates like the care plan oversight codes. For more information about care plan oversight, see "How to Document and Bill Care Plan Oversight," FPM, May 2005.
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.
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.
Send comments to fpmedit@aafp.org.
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