CODING & DOCUMENTATION
Answers to Your Questions
Fam Pract Manag. 2004 Jul-Aug;11(7):19-20.
- 99211 & immunizations
- “Self-limited, minor” problems
- After office hours
- Multiple procedures at the same visit
- HCPCS codes for Nubain & Phenergan
- Benadryl injection
99211 & immunizations
Can 99211 and 90471 ever be submitted together for the same visit? For example, could both codes be submitted if a nurse takes a temperature before administering an immunization?
Submitting 99211 and 90471 for the same visit can be appropriate if the E/M service represented by 99211 is significant and separately identifiable from the immunization administration, according to CPT. The CPT manual states that “if a significant separately identifiable [E/M] service (e.g., office or other outpatient services, preventive medicine services) is performed, the appropriate E/M service code should be reported in addition to the vaccine and toxoid administration codes.”
Although CPT does not specify what must occur for 99211 to be a “significant separately identifiable” service and the use of 99211 does not involve any particular level of history, exam or medical decision making, the code still requires some “evaluation and management” of the patient. I do not believe that simply taking the patient’s temperature would meet this requirement.
“Self-limited, minor” problems
In the Documentation Guidelines for Evaluation and Management Services, how do you distinguish a “self-limited, minor” problem from other problems?
According to CPT, a self-limited, minor problem “runs a definite and prescribed course, is transient in nature and is not likely to permanently alter health status, or has a good prognosis with management/compliance.” Examples of these types of problems can be found in the documentation guidelines and CPT. For instance, the Table of Risk in the documentation guidelines lists a cold, an insect bite and tinea corporis as examples of self-limited or minor problems that represent a “minimal” level of risk. CPT codes 99201 and 99212 typically involve self-limited or minor problems. Examples are listed under these codes in Appendix C of CPT 2004.
After office hours
When is it appropriate to use CPT code 99050, “Services requested after posted office hours in addition to basic service” – when a physician provides services outside a normal 40-hour workweek or 8-hour day, or when services are provided outside posted office hours?
This code should be submitted in addition to the code for the basic service rendered when a service is provided after the office’s posted hours of business. The code is intended for those situations in which a physician agrees to stay beyond the posted office hours (or open the office outside posted office hours) to see a patient. In fact, the word “posted” was added to the 99050 code descriptor in 2004 to clarify this point.
Multiple procedures at the same visit
What code(s) should I submit for multiple procedures done at the same visit? Should the procedure with the highest relative value units (RVUs) be listed first?
When a physician performs multiple non-E/M procedures at the same visit, the code for the primary procedure or service should be listed first. This is typically the most extensive procedure, which is reflected in the RVUs assigned to that service. The additional procedure codes should be listed with modifier -51, “Multiple procedures,” attached to each (unless CPT indicates that a particular code is exempt from modifier -51).
HCPCS codes for Nubain & Phenergan
What HCPCS codes should we submit for Nubain and Phenergan?
You should submit J2300, “Injection, nalbuphine HCl, per 10 mg,” for Nubain. The appropriate code for Phenergan will depend on whether it is injectable or oral. For injectable Phenergan, you should submit J2550, “Injection, promethazine HCl, up to 50 mg”; and for oral Phenergan, you can submit Q0169, “Promethazine HCl, 12.5 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen,” or Q0170, “Promethazine HCl, 25 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen.”
What is the HCPCS code for a Benadryl injection?
The correct code is J1200, “Injection, diphenhydramine HCl, up to 50 mg.”
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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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