CODING & DOCUMENTATION

 

Fam Pract Manag. 2021 Sep-Oct;28(5):36.

Author disclosure: no relevant financial affiliations.

NEW VS. ESTABLISHED PATIENTS WHEN COVERING FOR OTHER PHYSICIANS

Q

A family physician from another group practice and I often provide coverage for each other. When I see the other physician's patients for the first time, should I report them as new patient visits?

A

No. CPT instructs that when a patient receives services from an on-call physician or one who is covering for another physician, the services are classified as if they were provided by the physician who is not available. If the patient would be established to the primary physician, then the patient is considered established to the covering physician as well.

CODING FOR WEEKEND CLINIC SERVICES

Q

Is it appropriate to code 99051 for claims to non-Medicare health plans for services provided during our normal Saturday morning clinic?

A

Yes. CPT code 99051, “Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours,” is reported in addition to codes for the services provided (e.g., office visit or laceration repair). While some payers, including Medicare, will not provide separate payment for code 99051, others do. Separate payment for this code recognizes that extended primary care office hours allow patients to avoid pricier visits to urgent care or emergency departments. Payers may also pay separately for code 99050, “Service(s) provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed.”

INCIDENT-TO RULES FOR MEDICARE ADVANTAGE PLANS

Q

Do Medicare Advantage plans allow the reporting of services by advanced practice providers under the Medicare incident-to provisions?

A

Generally, yes. However, at least one Medicare Advantage plan (Anthem of Virginia) has a policy to not pay for incident-to s

ABOUT THE AUTHOR

Cindy Hughes is an independent consulting editor based in El Dorado, Kan., and a contributing editor to FPM.

Author disclosure: no relevant financial affiliations.

WE WANT TO HEAR FROM YOU

Send questions and comments to fpmedit@aafp.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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