A No-Risk Plan for Coding Initial and Repeat Pap Smears   (April 2002)

Pap smears are covered every two years for low-risk Medicare patients and annually for high-risk patients. But, family practice coders may face uncertainty when the physician has to perform the initial Pap smear or repeat the test. Understanding how to code the initial Pap will help coders when the repeat is performed.  “Sometimes a doctor receives abnormal results back from the lab and decides to repeat the test either to confirm the first result or [...]

You Be the Coder: Preventive Exam with Vision Screening   (April 2002)

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: When a patient comes in for a preventive exam and the doctor performs a vision screening as well, can we bill separately for both?Georgia Subscriber

Medicare Now Covers IVIg for Specific Skin Diseases   (April 2002)

Family practices can now receive reimbursement for intravenous immune globulin treatment (IVIg) on Medicare patients with five specific mucocutaneous blistering diseases. “Although these are rare diseases, we sometimes see patients with them,” says Daniel Fick, MD, director of risk management and compliance for the College of Medicine Faculty Practice Plan at the University of Iowa in Iowa City. “Usually, the patients have been evaluated by a dermatologist and then sent to their family physician for continued [...]

Reader Question: Preoperative Testing   (April 2002)

Question: Our doctor does preoperative testing on patients. Usually the pre-op includes an E/M and an electrocardiogram (ECG). Can we charge for this service? If so, how should we bill it?  Wisconsin Subscriber
 Answer: Yes, you can bill for preoperative testing performed by the FP. Use the consultation codes (99241-99245) for the patient evaluation, if the preoperative testing was done at the request of the physician performing surgery. The surgeon is essentially seeking the FPs opinion [...]

Reader Question: Disability Paperwork   (April 2002)

Question: Can we charge the insurance company for having the physician complete disability paperwork? Most of the paperwork is 10 pages long and takes a lot of the doctors time. New York Subscriber
 Answer: You can charge for filling out disability paperwork by billing 99080 (Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form) with the appropriate E/M office visit code. Code 99080 is an [...]

Reader Question: Two Doctors Performing Critical Care   (April 2002)

Question: Our FP was paged to the emergency room (ER) at 1 a.m. to treat one of his patients with significant heart disease. The patient was arresting when he arrived, and the doctor performed chest compressions and talked with the patients family. The ER doctors want to bill critical care, and our doctor wants to bill critical care. Can we both report it? Florida Subscriber
 Answer: Both doctors can bill the appropriate critical care codes (99291-+99292). [...]

Reader Question: Podophyllin Treatment of Warts   (April 2002)

Question: How should I code for podophyllin treatment of four vaginal warts? We are using 17110* but getting denials.Kansas Subscriber
Answer: Although 17110* (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of flat warts, molluscum contagiosum, or milia; up to 14 lesions) describes the destruction of warts, it is not the most accurate code in your case. In the notes preceding the skin lesion destruction codes, CPT says, “for destruction of lesion[s] in specific anatomic [...]

Reader Question: Sick-Building Syndrome   (April 2002)

Question: Which code should we use for sick-building syndrome? Nevada Subscriber
 Answer: Sick-building syndrome is a collection of complaints with variable findings, not an actual disease. Patients who work in buildings with poor ventilation that may spread fungus, bacteria and other harmful organisms are said to have sick-building syndrome. There is no specific code for this, so code for the patients symptoms. Patients with this syndrome often present with shortness of breath (786.05), fatigue (780.79), cough [...]

Straightforward Coding Guidance for   (March 2002)

Family physicians (FPs) perform proctosigmoidoscopies (proctos) and flexible sigmoidoscopies (flex sigs) to examine a patients rectum and distal colon for screening, diagnosis or treatment of a problem. FP coders must know how to bill for these procedures when they are screenings, when theyre performed due to a patient complaint, and when they are discontinued. To perform a proctosigmoidoscopy, the FP inserts a rigid endoscope in the rectum and sigmoid colon. A procto is usually performed because [...]

New Rules Beckon Proper Use of Medical Nutrition Codes   (March 2002)

Family physicians have a new option for providing nutrition counseling to Medicare patients with diabetes or renal disease. Medicare rules were recently finalized for medical nutrition therapy (MNT) codes 97802-97804, which provide payment for outpatient counseling by registered dietitians or nutritionists in an individual or group setting. The codes, covered by Medicare effective Jan. 1, 2002, are:
97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with patient, each 15 minutes
97803 re-assessment [...]