CODING & DOCUMENTATION
Answers to Your Questions
Fam Pract Manag. 2004 Sep;11(8):23.
School physical forms
What code(s) should I submit for filling out school physical forms outside of an office visit? Would 99080, “Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form,” be appropriate?
There is no specific CPT code for completing a school physical form outside a visit. According to CPT, 99080 is to be used as an adjunct to the basic service(s) rendered, which means it should not typically be reported by itself. You might consider submitting an unlisted CPT code, such as 99199, “Unlisted special service, procedure or report,” and then indicating on the claim form specifically what service this is intended to represent (school physical forms, in your case).
Hospital care for partner’s patients
If I am asked by our nursing staff to evaluate one of my partner’s hospitalized patients while I’m on call for the night, can I submit a code for my services even if my partner is also submitting a code for his services provided earlier in the day?
Generally, no. CPT’s hospital care codes (99221-99233) are “per day” codes, which means that the code and the payment established for the code represent all services provided on that date. CPT states that “in the instance where a physician is on call for or covering for another physician, the patient’s encounter will be classified as it would have been by the physician who is not available.” The Medicare Claims Processing Manual supports this interpretation: “Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. If more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one [E/M] service may be reported unless the [E/M] services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level.” This manual also addresses hospital care specifically, stating that if physician A sees the inpatient in the morning and physician B, who is covering for A, sees the same patient in the evening, it is generally not appropriate for both physicians to code and be paid for hospital care since the hospital care code submitted by either one is intended to cover care for the whole day.
Although not typical in family medicine practices, there are a couple of different situations that would allow for different codes to be submitted by different physicians on the same date in the situation you describe:
Medicare and some other payers may reimburse for “concurrent care” under certain circumstances (e.g., when physicians are in different specialties, when each physician is responsible for a different aspect of the patient’s care or when the visits are billed with different diagnoses).
If you are called in to provide a consultation on your partner’s hospitalized patient because the problem is outside your partner’s area of expertise, it would be appropriate for you to submit an inpatient consultation code (e.g., 99253) on the same date that your partner submits a hospital care code. In this case, the patient’s medical record should reflect that your partner requested your opinion or advice regarding evaluation and/or management of a specific problem, and you should provide your partner with written communication about your opinion or advice.
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.
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