Sep-Oct 2008 Table of Contents

Coding & Documentation

Fam Pract Manag. 2008 Sep-Oct;15(8):42.

99211 for nursing visit

Q

In your March 2008 column, you indicated that a 99211 could be billed for a brief nursing visit for a urinary tract infection if a chief complaint, history of the present illness (HPI) and urinalysis results are documented and instructions or medications are given. If the patient is not seeing a physician, how do you get past the rule (for Medicare) that ancillary staff should not be documenting the HPI?

A

That rule does not apply to code 99211 because the 99211 service does not require the key components as defined in the “Documentation Guidelines for Evaluation and Management Services.” Physician documentation or review of the HPI is only required for levels of service other than 99211.

Same-day admission and discharge

Q

I phoned in admission orders at 10 p.m., saw the patient the next morning and discharged her later that day. Can I bill for admit and discharge on the same date?

A

By CPT standards, the answer is yes. Because you provided the face-to-face initial hospital care on the same date as the discharge service, codes 99234-99236 might apply to your services.

However, if the payer is Medicare, these codes may only be reported if the duration of the patient's stay was at least eight hours and less than 24 hours on the same date. If the stay was less than eight hours, only the initial hospital care (or initial observation care, if the patient was admitted in observation status) should be reported to Medicare.

ICD-9 code for CPK

Q

What is the correct ICD-9 code for an elevated creatinine phosphokinase (CPK) result?

A

It's 790.5, “Other nonspecific abnormal serum enzyme levels.” This is difficult to locate in the ICD-9 manual because it is not listed by name in the index. Rather, it appears under the heading “Findings, abnormal, without diagnosis,” and then under the term “enzymes, serum not elsewhere classified.”

No-show tracking

Q

Is there a CPT code for a no-show appointment?

A

No. For tracking purposes, practices might develop a pseudocode such as NOSHO for applying such charges to a patient's account. Practices that develop a no-show policy that applies to all patients and conforms with any applicable state laws may charge patients a stated fee for missed appointments, even Medicare patients.

RSV testing in the office

Q

Is respiratory syncytial virus (RSV) testing done in the office reimbursable? We send the specimen we collect to the lab.

A

The collection of the specimen would be included in the reimbursement for the E/M service provided on that date; it can't be separately billed. A limited number of payers may provide reimbursement for preparing and conveying the specimen from the physician's office to the laboratory; this should be reported with code 99000.

About the Author

Cindy Hughes is the AAFP's coding and compliance specialist and is a contributing editor to Family Practice Management. Author disclosure: nothing to disclose. These answers were reviewed by 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; Emily Hill, PA-C; Kent Moore; Joy Newby, LPN, CPC; P. Lynn Sallings, CPC; and Susan Welsh, CPC, MHA.

Editor's note: While this department attempts to provide accurate information and useful advice, payers may not accept the coding and documentation recommended. 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.

 

Copyright © 2008 by the American Academy of Family Physicians.
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