CODING & DOCUMENTATION
Fam Pract Manag. 2006 Jun;13(6):30.
- 99211 for a blood pressure check
- OB care before and after a C-section
- Counseling when the patient is not present
- Diagnosis codes for Medicare's initial exam
99211 for a blood pressure check
A patient came in recently for a blood pressure check. Can we bill 99211 if our medical assistant (MA) checks the patient's blood pressure and I co-sign, or do I actually have to see the patient?
If the MA is working “incident to” you (i.e., you are in the office but not necessarily in the room, and you have initiated the course of care pertaining to the reason for the visit), you can bill 99211 for the visit. Even if you don't see the patient, you must document your involvement with the patient's care in the chart. Documentation should include a brief note regarding the reason for the visit, the patient's complaints or symptoms, the recorded blood pressure and any follow-up you plan.
OB care before and after a C-section
I recently provided obstetric care for a patient through all three trimesters of her pregnancy. After more than 24 hours on the labor and delivery floor, she required a Cesarean section. Can I bill the antepartum care, initial hospital admission and critical care services, in addition to the C-section assist code?
Yes you can, although the hospital admission will likely be bundled with the antepartum care. When billing for less than the global OB package, see 59425-59426 for antepartum care. (For details on the global OB package and what it covers, see the introduction to the Maternity Care and Delivery section of CPT.) If you provide the postpartum care, code 59430 would be reportable as well. Note that each payer may set guidelines for obstetric care that might not follow the conventions of CPT. Contact your payers to determine what they will allow.
Counseling when the patient is not present
How should I bill for a family conference regarding end-of-life issues when the patient is not present?
This depends on the payer. CPT defines the counseling component of an E/M service as a discussion with a patient and/or family concerning one of several areas described in the definition. One of the areas is prognosis, and another is risks and benefits of management options. However, Medicare and some other payers require that E/M services include face-to-face services with the patient. Contact your payers to determine how best to bill for these services. If the patient's health plan won't reimburse you for the services, the family member's health plan might. If you bill the counseling service to the family member's insurer, consider using diagnosis code V61.49, “Other health problems within family,” and an E/M code based on the documented time spent counseling.
Diagnosis codes for Medicare's initial exam
What diagnosis code should I report with Medicare's initial preventive physical exam (IPPE) and an ECG?
CMS did not specify which diagnoses are payable for the IPPE but left that to its carriers to determine. ICD-9 code V70.0, “Routine general medical examination at a health care facility,” could be used, but code V70.5, “Health examination of defined subpopulations,” also seems appropriate. To be sure, contact your local Medicare carrier to ask if a policy has been set.
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 © 2006 by the American Academy of Family Physicians.
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