Assisting Surgeons Use Same Code as Primary Surgeons   (February 2002)

About one of every four family physicians serves as an assistant at surgery, according to the American Academy of Family Physicians (AAFP) 2001 practice profile survey. To be reimbursed for the surgery, the physician’s office must use the proper procedure code, append a modifier and, in some cases, document the medical reason an assistant was needed. The assisting surgeon uses the same procedure code as the primary surgeon and appends modifier -80 (assistant surgeon) or uses [...]

New CCI Edits Have Few Changes for Family Practices   (February 2002)

CMS released the national Correct Coding Initiative (CCI) edits version 8.0 effective Jan. 1, 2002. The new edits replace all preceding versions and remain in effect through March 31.    The main changes affect the anesthesia (00100-01999) and surgery (10021-69990) sections of CPT. A few changes affect family physicians. Skin debridement codes are: 11040 debridement; skin, partial thickness 11041 … skin, full thickness 11042 … skin, and subcutaneous tissue 11043 … skin, [...]

Reader Question: Hospital Admission   (February 2002)

Question: A patient presents to the office, and the physician determines she needs to be admitted to the hospital that day. What is the proper way to bill for this? Should we use an E/M code for the office visit, a hospital admission code, or both?Georgia Subscriber
 Answer: Report the appropriate hospital admission code, 99221-99223, initial hospital care, new or established patient. You can bill only one E/M code in this situation, but you can use [...]

Reader Question: Nursing Home   (February 2002)

Question: Our physician sees patients in a nursing home, and while he is making rounds, patients from a rest home next door walk over to the nursing home waiting room and are seen by the doctor. We billed this as an office visit because the doctor is using the waiting room as his office, but Medicare denies it. What are we doing wrong?California Subscriber
 Answer: You cannot bill this as an office visit because the physician [...]

Reader Question: Bicillin   (February 2002)

Question: When a patient comes in for an office visit and is given an injection of Bicillin (90788), we use the diagnosis code for bronchitis. Does the office visit need a separate diagnosis code so the injection is not bundled with the E/M service?Texas Subscriber
Answer: For a Medicare patient, bill for the office visit (99201-99215) and the J code for Bicillin (J0530-J0580). Use the diagnosis for bronchitis (e.g., 490, bronchitis, not specified as acute or [...]

CMS Clarifies When To Code Diagnostic Tests Based on the Results   (January 2002)

CMS’ recent program memorandum (transmittal AB-01-144) reminded Medicare carriers of the proper ICD-9 codes for diagnostic tests. While the memo reiterates many standard policies, it also clarifies a common confusion by telling practices when it is appropriate to code diagnostic tests based on the results. Family practice coders need to know all the specific ICD-9 guidelines for diagnostic tests or they could face denials and lose out on fair reimbursement. “A lot of the information in [...]

Avoid Modifier Missteps To Reduce Denials   (January 2002)

Modifiers remain a mystery to many coders who think they know how and when to append them, yet frequently find their claims denied. The problem is so pervasive that improper use of modifiers has been cited as one of the top-10 billing errors by federal, state and private payers and is considered a major fraud, abuse and noncompliance issue.  Following are some of the modifiers used most often by family physicians, common mistakes in appending [...]

You Be the Coder: Daughter Seeking Advice for Mother   (January 2002)

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: A patient came in to discuss the supportive care of her mother, a Medicare recipient who is also our patient. Should I use the confirmatory consultation codes (99271-99275) for this visit?Alabama Subscriber

Answer: The confirmatory consultation codes are not appropriate in this case because they apply only when the physician gives a second or third opinion on the necessity [...]

Anthrax Coding Report Free on Web   (January 2002)

Physicians and other healthcare professionals who provide services to any patients with actual or possible anthrax exposure know that the encounters must be correctly coded. This is necessary for accurate health records and insurance claims; it is also mandated by law. Until now, however, there has been no central compen-dium of anthrax coding information and advice. Therefore, The Coding Institute organized a task force to provide a special report on anthrax coding. This 16-page report has been [...]

Reader Question: Is This Visit Preventive or Problem-Oriented?   (January 2002)

Question: An established patient scheduled an annual physical, but when he came in he complained about several chronic problems that had been acting up. The physician performed an examination to check on the chronic conditions, taking thorough documentation, and billed the encounter as an established patient outpatient visit. The physician said the visit had changed from a preventive visit (annual physical) to a problem-oriented visit, but what about the intent of the visit? I thought [...]