CODING & DOCUMENTATION
Fam Pract Manag. 2020 Jan-Feb;27(1):33.
Author disclosure: no relevant financial affiliations disclosed.
- VAPING-RELATED ILLNESS
- BILLING “QUALIFIED MEDICARE BENEFICIARIES”
- ELECTROCARDIOGRAM RECORDED BY A HOLTER MONITOR
- LUNG FUNCTION TESTS
I am seeing patients with respiratory symptoms associated with vaping (e.g., cough or chest pain). What code should we report to indicate this?
Assign a code for the patient’s diagnosed condition or symptoms. For patients with acute lung injury but no further documentation of a specific condition, such as bronchitis or pneumonitis, you can assign ICD-10 code J68.9 for “Unspecified respiratory condition due to chemicals, gases, fumes, and vapors.” For symptoms attributed to exposure to vaping, also assign code Z77.29, “Contact with and (suspected) exposure to other hazardous substances.” If the patient is nicotine-dependent and using electronic cigarettes (i.e., vaping a nicotine product), also assign a code from category F17.29-(sixth character required) for “Nicotine dependence, other tobacco product.” At this time there is no diagnostic code specific to vaping, but that may change in the future.
BILLING “QUALIFIED MEDICARE BENEFICIARIES”
Our billing office has received calls from patients and families stating that our office is not allowed to bill them for the Medicare deductible and coinsurance amounts because the patient is a Qualified Medicare Beneficiary (QMB). Is this correct? If so, how do we identify these patients?
This is correct. Federal law prohibits billing patients who are QMBs, which are Medicare recipients who meet certain income limits. This rule applies whether or not your practice accepts Medicaid (which covers out-of-pocket costs for some QMBs). QMBs may be covered by original Medicare Part B or a Medicare Advantage plan. For patients covered by Medicare Part B, your staff can verify QMB status prior to the first visit through the Centers for Medicare & Medicaid Services’ HIPAA Eligibility Transaction System (HETS), or in the patient eligibility profile of your
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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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