CODING & DOCUMENTATION
Fam Pract Manag. 2005 Sep;12(8):26-27.
- Hypertension management
- Coding a B12 injection
- Biofeedback training
- House visits to hospice patients
- Billing for initial hospital care
- Coding a newborn office visit
I recently saw an asymptomatic patient in the clinic for hypertension management. His blood pressure was 160/96 mm Hg, so I added another hypertension medication to his current regimen. What ICD-9 code should I submit for this?
Because you are controlling the patient’s blood pressure with medicine and do not note any symptom of malignant hypertension, you should submit 401.1, “Essential hypertension; benign.”
Coding a B12 injection
Is 90782, “Therapeutic, prophylactic or diagnostic injection (specify material injected); subcutaneous or intramuscular,” the proper code for administering a vitamin B12 injection in the office if the patient provides the medication? Would the codes be the same if the office provided the medication?
90782 would be correct for a patient with private insurance. However, for patients covered by Medicare, code G0351 would be the injection code for 2005. J3420, “Injection, vitamin B12 cyanocobalamin, up to 1,000mcg,” is the HCPCS code for reporting physician provision of the medication.
How should we bill for urinary and fecal incontinence biofeedback training?
You should use code 90911, “Biofeedback training by any modality.” Although code 51784, “Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique,” has a higher relative value unit (RVU) for Medicare patients, it is bundled with code 90911, as is 97530, “Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes.” If the initial visit involves only an evaluation and not training, bill the appropriate evaluation and management (E/M) code.
House visits to hospice patients
How do I bill for a home visit to a Medicare hospice patient?
Choose a code from the home services series, 99341–99350, to report a home visit. The beneficiary does not need to be confined to the home for you to be reimbursed for these codes, but the medical record must document why it was medically necessary to make a home visit in lieu of an office or outpatient visit.
When billing Medicare for services provided to a hospice patient, two questions must be asked:
Will you be paid directly by hospice for the services? If not, report services related to the condition for which the patient is enrolled in hospice to Medicare using modifier -GV, “Attending physician not employed or paid under arrangement by the patient’s hospice provider.”
Is the service unrelated to the condition for which the patient is enrolled in hospice? If the service is not related to the terminal condition, you should report modifier -GW, “Service not related to hospice patient’s terminal condition.” For example, if you see a patient with cancer who is receiving hospice care and the purpose of your visit is to treat an unrelated minor infection.
Billing for initial hospital care
If I admit a patient under observation status for another physician who is not in my group, and the patient stays longer than allowed for observation, can that physician then charge an additional initial hospital care code after the observation period ends because the patient was changed to full admission status?
It depends. If full admission is medically necessary and all of the elements are documented, the second physician can bill an initial hospital care code (99221–99223) or a subsequent hospital care code (99231–99233) if the patient required a lower level of care. But if you admit the patient to observation and the patient’s physician admits the patient as an inpatient on the same calendar date, only one of you can report the service. The descriptors of these codes include the phrase “per day,” meaning care for the day. The initial inpatient hospital care is the only service that should be reported.
Coding a newborn office visit
Does a newborn seen for a first office visit warrant a new patient E/M code even if a member of our group already saw the newborn in the hospital?
CPT defines a new patient as “one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years.” If the member of your group who saw the newborn in the hospital is of the same specialty as the physician seeing the newborn in the office, then the office visit is for an established patient. If the physicians are of different specialties, such as a pediatrician in the hospital and a family physician in the office, then the patient is considered new.
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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 Medicare’s 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 © 2005 by the American Academy of Family Physicians.
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