CODING & DOCUMENTATION

 

Fam Pract Manag. 2009 Mar-Apr;16(2):32.

Pap test

Q

How should we code Pap tests for non-Medicare patients? We currently use a preventive medicine services code. Should we use 88142?

The codes for preventive medicine services, 99381–99397, include an age- and gender-appropriate exam. Collection of the Pap test specimen is part of the pelvic exam, according to CPT guidelines. Code 88142 is for performing the related pathology service.

ECG technical component

Q

If I read an ECG for a patient in the hospital, can I bill for the technical component?

The party billing for the technical component should be the party that provides the equipment and pays the associated overhead costs (e.g., supplies and staff time). The reading or interpretation and report of an ECG is the professional component of the service. CPT includes codes for the full service (technical and professional), technical component only and professional component only. For 12-lead ECGs, these codes are 93000, 93005 and 93010, respectively. In your example, the hospital would bill 93005 and you would bill 93010.

Lesion removal by shaving

Q

If I perform an excision of a skin lesion by shaving and send the specimen to pathology, should I code it as a biopsy since I would be sending the entire lesion for diagnosis?

The code selection depends on the reason for removal. Removal of a lesion by shaving, codes 11300–11313 (differentiated by body area and lesion diameter), may be reported for lesions that require only superficial removal, such as a benign-appearing nevus on a body area subject to trauma. Biopsy codes 11100–11101 should be reported when the intent is to obtain tissue to send to pathology (e.g., biopsy of a suspicious lesion using shave technique). Codes for excision of benign lesions (e.g., 11400–11471) or malignant lesions (e.g., 11600–11646) should be reported for full-thickness removal (through the dermis), including margins.

Counting exam elements

Q

Does examining the pulses on a patient’s extremity (dorsalis pedis and posterior tibial pulses) constitute one bulleted element or two?

You should count it as one element. The counting of bulleted elements in a physical exam relates to the 1997 version of the Documentation Guidelines for Evaluation and Management Services. The description of the general multisystem exam included in the guidelines lists “pedal pulses” as one bulleted element of the cardiovascular system. In some cases, the guidelines specify the number of exam components that must be covered for a bulleted item to be counted (e.g., three vital signs must be documented for one bulleted element of the Constitutional system). Those with multiple components but no numeric requirement specified in the guidelines, such as pedal pulses, are counted as one regardless of how many components are documented. The guidelines require that physicians document one component in such cases.

Editor’s note: While we attempt to provide accurate advice, payers may not accept the coding and documentation recommended. Refer to the CPT and ICD-9 manuals and the Documentation Guidelines for Evaluation and Management Services for the most detailed, up-to-date information.

 

About the Author

Cindy Hughes is the AAFP’s coding and compliance specialist, a contributing editor to Family Practice Management and co-author of the FPM blog Getting Paid (http://blogs.aafp.org/fpm/gettingpaid). 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.

WE WANT TO HEAR FROM YOU

Send questions and comments to fpmedit@aafp.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 © 2009 by the American Academy of Family Physicians.
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