CODING & DOCUMENTATION
Fam Pract Manag. 2005 May;14(5):16.
- 99214 + Welcome to Medicare exam?
- Billing for nutritional education
- Dressing changes
- 86580 for tuberculosis testing
99214 + Welcome to Medicare exam?
Can I bill 99214 and a Welcome to Medicare exam (G0344) at the same visit?
Yes. Append modifier -25 to the evaluation and management (E/M) code to signify that the problem-oriented service was significant and separately identifiable from the work of the preventive service. Many coding professionals recommend that you create two separate notes to help identify which work was associated with each code. This may help to support your claim. Remember that each element of work you perform at the visit can count toward only one of the two services.
Billing for nutritional education
How should we code for nutritional education during a problem-oriented visit when we discuss good eating habits with a child battling obesity?
If you spend more than half of your face-to-face time counseling the child or the child's caregiver regarding obesity-related health concerns and risk-factor reduction, you may choose a level of service based on time rather than the history, exam and medical decision making components of the service (see “Time Is of the Essence: Coding on the Basis of Time for Physician Services,” FPM, June 2003). Be aware that not all insurers cover services related to obesity.
If a patient comes in with a skin tear or burn and then returns daily for me to change the dressing, can I bill an E/M code for each visit?
If there was a global period assigned to the initial service you provided, you cannot separately report each dressing change. Reimbursement for any dressing changes provided within that time frame is included in the global fee.
If a global period does not apply, you may report dressing changes using an E/M code. If the dressing change is performed by nursing staff under incident-to conditions, you may use code 99211. When performed by a physician, dressing changes for burns and debridement of burn tissue should be reported using codes 16020–16030, depending on the size of the burn.
86580 for tuberculosis testing
If I perform a purified protein derivative (PPD) test for tuberculosis, should I report code 90772, “Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular,” in addition to code 86580, “Skin test; tuberculosis, intradermal”?
No. Code 90772 does not accurately describe the procedure. You should report only code 86580, which includes the intradermal injection. If on a later date you examine the injection site for a reaction, then you may report an E/M code for the services rendered on that date. If a nursing staff member performs the exam of the injection site, it may be reported with code 99211. Incident-to rules may apply for 99211 services, so check with your payer.
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 © 2005 by the American Academy of Family Physicians.
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