Reader Question: Discharged Patients   (February 2001)

Question: Are there any guidelines explaining what effect discharge has on billing for 99285? We have quite a few patients who are discharged and coded this way, usually after an evaluation for chest or abdominal pain. There are some scenarios in which the symptoms are obvious (septic workup in a dehydrated child who has intravenous [IV] hydration, meds, labs, coordination of care). Arizona Subscriber Answer: Experts agree that patients who present with chest pain that is [...]

Reader Question: Gastritis With Hemorrhage   (February 2001)

Question: Are gastritis and gastrointestinal bleeding in a final diagnosis coded individually or as gastritis with hemorrhage?Camille VillanuevaFort Myers, Fla. Answer: You would code gastritis with the fifth digit that represents with hemorrhage, ICD-9 code 535.01. You would use 535.00 for without hemorrhage. Sources for You Be the Coder and Reader Questions are Penny Lodes, CPC, independent coding consultant in Appleton, Wis.; Michael Granovsky, MD, chief financial officer of Greater Washington Emergency Physicians, a five-physician group staffing [...]

Understand the Changes to Critical Care Services in CPT^® 2001 for Proper Reimbursement   (January 2001)

CPT has revised the language for critical care and has increased relative value units (RVUs) for 99291 (critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and 99292 (… each additional 30 minutes). Coders must know what these changes mean and how they will affect coding. My general feeling is that the definition of critical care, as it is spelled out for 2001, is considerably looser than it was [...]

CPT^® 2001: Medicare Revises Observation and Inpatient Hospital Care Payment Policy   (January 2001)

Medicare has revised its payment policy for observation and inpatient hospital care services when the patient is admitted and then discharged more than eight hours later, but still on the same day. Previously, physicians would have reported 99218-99220 (initial observation care, per day, for the evaluation and management of a patient) for this service. But effective Jan. 1, 2001, they should report 99234-99236 (observation or inpatient hospital care, for the evaluation and management of a [...]

You Be the Coder: Foreign Body in Forehead   (January 2001)

Question: How should I code for foreign body removal from scalp/forehead if the item was glass? How about 20520 or 11010?John FinkDearborn, Mich.Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Answer: The code for removal of glass from the scalp is 10120* (incision and removal of foreign body, subcutaneous tissues; simple) or 10121 for a complicated removal. For 10120* this would include suturing, [...]

Reader Question: Stab Wounds   (January 2001)

Question: A patient presented to the ED waiting room with multiple stab wounds. From documentation, it appears appropriate assessments were performed, IVs initiated, units of blood given, etc. Documentation regarding wound care described locations of about 12 stab wounds, but only one of these wounds had additional description: stab wound LUQ abd w/ peritoneal tissue protruding … wounds dressed with Vaseline gauze. The patient was transferred to trauma center about 30 minutes after his arrival. [...]

Reader Question: E/M Coding   (January 2001)

Question: Evaluation and management (E/M) has three components: history, exam and decision-making. Do all three of these components have to be the same levels? Thomas Foreman, MDHornell, N.Y. Answer: The lowest component decides which code should be used. For example, if the history is problem focused, the examination is detailed and the level of decision-making is moderate, then the proper code is 99201 (office or other outpatient visit for the evaluation and management of a [...]

Reader Question: Coding for 99288   (January 2001)

Question: When coding for 99288 (physician direction of emergency medical systems [EMS] emergency care, advanced life support) are any guidelines available that provide standards and/or specific documentation that is required when assigning this code for billing? For example, can we use this code only in advanced life support circumstances such as respiratory failure? Barbara GedwillMequon, Wis. Answer: There are no specific guidelines, outside of the instructions in CPT, page 21 of the 2000 professional edition [...]

Reader Question: 92012 and Modifier -25   (January 2001)

Question: Does modifier -25 apply only to E/M codes with Medicare or does it also apply to a 92012 code for a Medicare patient? Robert BellinoffEl Dorado Hills, Calif. Answer: In the scope of the 92012 (ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient) CPT code description it states that, along with the medical examination and evaluation, initiation or continuation of a diagnostic treatment program [...]

Reader Question: 90675 and 90375   (January 2001)

Question: Are CPT codes 90675 and 90375 billable by the physician? And can we bill them together?Illinois Subscriber Answer: Codes 90675 (rabies vaccine, for intramuscular use) and 90375 (rabies immune globulin [RIg], human, for intramuscular and/or subcutaneous use) are two different items, and yes, you can bill them together if the physician administered them. But many carriers will not pay for this service because the nursing staff usually performs it. Check with your local carrier. Medicare [...]