99000 for transferring labs
An insurance carrier recently notified us that we should not bill for 99000, “Handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory,” when submitting charges for lab tests. It states that this is a code the laboratory should use when billing the insurance carrier for the test. However, we are doing the data input and packaging of the specimen, which are added expenses for our office. Is the insurance company interpreting this code accurately?
While this insurer’s interpretation of the code is unusual, it is common for insurers to bundle 99000 with other services performed on the same date. Your practice can bill for the conveyance of the specimen to the laboratory in addition to the office visit at which the need for the test was identified, but many insurers will only reimburse you for the office visit code.
Change of status
When the hospital retroactively changes one of my patients from observation status to inpatient status, can I then submit an initial hospital care code (99221-99223) in lieu of an initial observation code (99218-99220)?
It depends on the payer. Some payers, such as Medicare, may want you to use the code that reflects the patient’s status at the time the service was rendered, regardless of the subsequent change in status by the hospital. Of course, if the patient was admitted on a date subsequent to the date of observation care, both services can be billed. For instance, let’s say you admit a patient to observation on the 17th and his status is changed to inpatient on the 18th. If you provide initial observation care on the 17th and initial hospital care on the 18th, both are billable.
Counseling and vaccinations for travelers
I saw a patient for a 45-minute visit, and we discussed traveler’s diarrhea, travel safety, malaria prevention and prophylaxis, typhoid, hepatitis, HIV, and tuberculosis. It was mostly a counseling session, but I did prescribe some antiprotozoals for malaria prophylaxis, and we administered yellow fever and typhoid vaccines. How should I code for this visit?
Submit code 99403 for a preventive medicine counseling visit lasting approximately 45 minutes. You would also bill the vaccine administration code 90471 for one vaccine and 90472 for each additional vaccine. For example, if you administer three vaccines, you would code 90471 once and 90472 twice. (If the patient is under 8 years of age, you should submit 90465 and, when appropriate, 90466, instead.) Code separately for the actual vaccine products: 90717 for yellow fever and the appropriate code from 90690-90693 for typhoid.
Laser treatment of rosacea
Is there a code for laser treatment of rosacea?
Codes 17000-17004 should be used for laser treatment of the telangiectasia that occurs with rosacea. Note that codes 17106-17108 are intended only for congenital port wine stains and hemangiomas.
Send comments to fpmedit@aafp.org.
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.
