Unbilled services
What services are most commonly overlooked but should be billed for, in your experience?
Services that involve multiple codes seem to create the most confusion. For instance, a medication may be supplied and injected but only one of the two codes gets reported, leaving either the medication or the injection service unbilled. Sometimes services that are not paid for by one or more payers (oximetry, for example) don't get billed at all, even though some insurers do pay for them.
Same-day office visit and observation care
After seeing a two-year-old boy in my office who had failed outpatient hydration therapy and was in need of IV fluids, I admitted him to observation. Later that same date, I saw the patient again, completed hospital orders and dictated the full history and physical. He was discharged the next day. How do I best code both the office visit and the hospital visit that night, which was necessary for the care of the patient? I coded 99217 for the discharge.
Your evaluation and management services on the date of admission to observation should be reported with a code for initial observation care, 99218–99220. The level of service that you report would be based on the total work performed for that patient on that date, both in the office and at other sites of service.
Is transcription an “incident-to service”?
Does transcribing a physician's dictated information qualify as an “incident-to” service?
Transcription does not qualify as a service that would be billed under the incident-to guidelines. While incidental to a physician's service, transcription is included in the practice expense portion of the payment for the service provided.
Same-day preventive and E/M services
The issue of when to bill a problem-oriented evaluation and management (E/M) service with a preventive medicine service is confusing. If chronic problems are stable, should we charge for both services?
It depends on the amount of work necessary to determine whether the chronic problems are stable and whether current management should be continued or adjusted. Preventive services were not valued to include significant physician work related to management of chronic conditions (or acute problems that require the key components of a problem-oriented encounter), so you shouldn't automatically discount this work. One approach is to consider whether the patient would have presented for evaluation of current medical conditions if he or she had not been coming in for the preventive visit. If the answer is yes and the details of the encounter are properly documented, then you should report both E/M codes. If the answer is no, you should only report the preventive service.
Fluorescein eye testing
We perform fluorescein eye testing to check for corneal injury in patients with conjunctivitis. How should we bill for this test?
It should not be separately reported. It is included in the exam component of the service reported.
Editor's note: While this department attempts to provide accurate, useful information, some payers may not agree with the advice given. You should also refer to current CPT and ICD-9 manuals and payer policies.
