Fam Pract Manag. 2009 Sep-Oct;16(5):30.
- Home health services and private payers
- Three-day observation stay
- Documenting surgical assists
- Prolonged services
Home health services and private payers
What CPT codes should we use when billing a private payer for home health certification and recertification services?
CPT does not include codes for certification and recertification of home health services. G0179 (recertification) and G0180 (certification) were created specifically for billing Medicare-covered home health services provided as part of a home health care plan, including physicians' contacts with the home health agency and review of patient status reports. Some private payers may cover similar services using these codes; others may consider them to be part of care plan oversight, which is billed with CPT codes 99374-99375.
Three-day observation stay
I saw a patient at the hospital for observation care for three days. I reported 99219 for initial observation care services on day one, 99213 for observation care on day two and 99217 for observation care discharge services on day three. The hospital listed the patient as an outpatient all three days. Is there a better code than 99213 to use for day two? Also, should 99219 be billed with place-of-service code 22?
There is conflicting advice on how to code the second day of a three-day observation stay. Medicare specifically instructs physicians to report an office or other outpatient evaluation and management (E/M) service code (e.g., 99212-99215) in what they consider to be the rare occurrence of a three-day stay. CPT does not specifically address this, but the CPT Assistant newsletter published by the AMA has advised reporting the code for unlisted E/M services, 99499. Bill place-of-service code 22 with each of the five-digit codes you submit in this scenario.
Documenting surgical assists
We have been told by our coding experts that we must dictate a separate operative note documenting our role as assistant surgeon at C-sections and other surgeries in which we assist. I have assisted in surgery my entire career and have never been advised that this is necessary. Typically the operative note dictated by the surgeon will contain the details of the surgery along with the name of the assistant. The details of who did what are not spelled out. Please advise us of what is required.
Separate reporting is not commonly prescribed. Instead the surgeon to whom the physician provides assistance typically includes the name of the assistant surgeon and describes the work performed in the report. I would ask what prompted this requirement (e.g., local payer policy). You might also verify that they are attaching modifier 80 rather than modifier 62 to your surgical assist code, since modifier 62 denotes co-surgery and may prompt the request for additional documentation.
Is modifier 21 still appropriate for reporting prolonged services?
Modifier 21 was deleted from CPT in 2009. Instead refer to codes 99354-99357, which represent prolonged physician services “requiring direct (face-to-face) patient contact beyond the usual service.” These codes are meant to be reported in addition to E/M codes when the time a physician spends with a patient goes at least 30 minutes beyond the typical time listed for that service in the CPT manual. Codes 99358-99359, which represent prolonged services without face-to-face contact, are seldom paid.
Editor's note: While this department attempts to provide accurate, useful information, some payers may not agree with the advice given. You should also refer to current CPT and ICD-9 manuals and payer policies.
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