CODING & DOCUMENTATION
Fam Pract Manag. 2006 Nov-Dec;13(10):27.
- Using 82270 and G0107 for fecal occult test
- Average charges for E/M codes
- Time-based coding
- Preoperative consultations
Using 82270 and G0107 for fecal occult test
What code should I use to report a screening fecal occult blood test?
Most payers accept CPT code 82270, “Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (i.e., patient was provided three cards or single triple card for consecutive collection).” At this time, Medicare requires that you report this screening test using HCPCS code G0107. However, effective Jan. 1, 2007, G0107 will be retired, and you should use 82270 for reporting fecal occult blood tests to Medicare.
Average charges for E/M codes
Where can I find family physicians' average charges for E/M codes?
A list of family physicians' average fees for 18 evaluation and management (E/M) services is available on the AAFP Web site. The list, which is based on the 2005 AAFP Practice Profile II Survey, is available at http://www.aafp.org/online/en/home/aboutus/specialty/facts/17.html.
If my documentation for a patient visit indicates that I met all the requirements for a 99215 but the visit only lasted 25 minutes, can I still bill a 99215 even though CPT says a level-V established patient visit should require 40 minutes of my time?
Yes. The times published in CPT are typical for each of the office visits, but there is no requirement associated with them unless counseling or coordination of care accounts for more than 50 percent of the face-to-face time of the encounter. In such cases, you can code on the basis of time (see “Time Is of the Essence: Coding on the Basis of Time for Physician Services,” FPM, June 2003, to learn more). Be sure to also consider the medical necessity of the service you provided. Coding 99215 indicates that the presenting problem was of a severe nature, such that you provided and documented two of the three key components (i.e., comprehensive history, comprehensive exam and medical decision making of high complexity) and that each was medically necessary.
What levels of care can be reported for a preoperative consultation?
A preoperative consultation is no different from other consultations in terms of level of service. The level of service should be driven by the nature of the presenting problem and the risk associated with your recommendation to the requesting physician. Consider the history that is relevant to the patient's condition, the extent of examination necessary to ascertain the patient's current status and how each of these relate to the amount of risk to the patient in the operative and postoperative periods. Note that a preoperative consultation should be prompted by a problem or concern regarding the patient's ability to safely undergo the procedure.
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 email@example.com, 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 © 2006 by the American Academy of Family Physicians.
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