CODING & DOCUMENTATION
Answers to Your Questions
Fam Pract Manag. 2004 Mar;11(3):28-29.
- Prolonged services codes
- Coding an “interview” visit
- Postcircumcision service
- Casting & strapping
- Initial or subsequent hospital care?
Prolonged services codes
I read recently that CPT’s prolonged services codes (99354-99357) should be used only when you’ve exceeded the time component for the appropriate evaluation and management (E/M) visit code by at least 30 minutes. So, for example, to submit 99354 in addition to 99214, which is listed in CPT as 25 minutes, is it true that the total face-to face time would need to be at least 55 minutes?
Yes. To code 99354 with 99214, the total face-to-face time spent with the patient would need to be at least 30 minutes beyond the 25 minutes typically spent in a 99214 visit.
Coding an “interview” visit
How should I code for a visit in which a pregnant patient “interviews” me to decide whether she wants me to be her unborn child’s physician and I spend 20 minutes discussing her concerns and my education, philosophy of care, etc.? I tried submitting 99212 (based on 20 minutes of face-to-face time) and ICD-9 code V65.49, “Other specified counseling”; however, my billing service says I should use 99395, “Periodic comprehensive preventive medicine re-evaluation and management of an individual including an age- and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of the appropriate immunization(s), laboratory/diagnostic procedures, established patient; 18-39 years,” instead. Which is correct?
CPT code 99395 would not be appropriate for the visit you describe because it requires “an age- and gender-appropriate history, examination,” neither of which you did. Code 99212 would also not be appropriate for two reasons: 1) There is no apparent history, exam or medical decision making involved, and 2) From a CPT perspective, counseling is not occurring either because the focus of the interview is on you rather than the patient’s pregnancy.
There are a few different ways you can handle this type of visit:
You can look at this service as a courtesy visit that is intended to build the practice. In this case, no code is necessary, since no claim is generated.
If you’d prefer to charge for this service, you may want to consider the unlisted E/M code 99499 since there is not a specific CPT code that describes a patient “interviewing” a physician. If you use 99499, inform the mother that insurers will not typically pay for this service and that she will be responsible for the associated charges.
If the focus of the visit was on the patient’s general concerns about promoting her and her baby’s health, it may be appropriate to use 99401, “Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes.” This CPT code would also be consistent with the kind of diagnosis code you chose.
If you decide to submit either 99499 or 99401 for this encounter, the most appropriate diagnosis code would be V65.11, “Pediatric pre-birth visit for expectant mother,” which is new for 2004.
What CPT code should I submit for manually taking down adhesions of the glans penis following circumcision?
It depends on specifically what service was performed and when you performed it. When a newborn or very young infant returns to your office during the healing phase of the newborn circumcision (i.e., within seven to 10 days, which coincides with the usual global period most insurers apply), the postcircumcision service is usually considered part of the typical postoperative follow-up care (and, thus, part of the CPT surgical package) and is not coded separately. However, you could submit 99024, “Postoperative follow-up visit, normally included in the surgical package, to indicate that an E/M service was performed during a postoperative period for a reason(s) related to the original procedure.” In these cases, the adhesions are usually very slight, fragile and manually broken with minimal time or pain for the infant.
Postcircumcision adhesions developed in older infants can be quite dense, requiring you to provide pain relief by topical anesthesia or regional block and perform an instrumented lysis under sterile conditions in the office. This requires more skill than the earlier postcircumcision service, since tissues bleed more freely at older ages and postoperative pain must be dealt with. In this case, you should submit 54162, “Lysis or excision of penile postcircumcision adhesions.”
An alternative to 54162 is 54450, “Foreskin manipulation including lysis of preputial adhesions and stretching.” You should use this code if the foreskin is still partially adhered to the penis and creates problems (this will usually occur in children older than seven or adults). This code should not be reported with 54162.
Casting & strapping
A patient presented with swelling in her lower leg caused by a fall on the ice, so I took an X-ray in the office, applied a posterior splint and gave the patient crutches. Then I spoke with an orthopedist who was going to take over the patient’s care. CPT states that “if cast application or strapping is provided as an initial service in which no other procedure or treatment is performed or is expected to be performed by a physician rendering the initial care only, use the casting, strapping and/or supply code (99070) in addition to an [E/M] code as appropriate.” This is confusing to me. Can I submit the X-ray code too (perhaps with modifier -TC attached)?
In the scenario you describe, I would advise you to submit the following codes:
The X-ray code (but do not append the technical component modifier -TC if you provided the professional component of the service – the interpretation and report – in addition to the technical component);
The appropriate level E/M visit code with modifier -25 attached, assuming the key components of the E/M service were met and documented;
The strapping/splint code;
The supply code.
CPT clearly states that the casting and strapping codes may be used “when the cast application or strapping is an initial service performed without a restorative treatment or procedure(s) to stabilize or protect a fracture, injury or dislocation and/or to afford comfort to a patient.” I believe that the subsequent paragraph in CPT that you quoted is intended to convey that when casting or strapping is an initial service performed without restoration, the supply and appropriate E/M code may also be reported in addition to the casting or strapping code.
Initial or subsequent hospital care?
If I admit a patient to the hospital from the office and submit an office-visit code (because I did not see the patient in the hospital that day) and then a partner in my group sees the patient in the hospital the next day, should my partner submit a subsequent hospital care code? If so, how can that be done when, technically, the initial admission has not yet been billed?
In most cases, your partner should submit an initial hospital care code (99221-99223) for the visit, since this would represent the first hospital inpatient encounter with the patient.
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 © 2004 by the American Academy of Family Physicians.
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