Reader Question: No HPI Equals No Coding for New Patient   (January 2012)

Question: A new patient visits the physician with a chief complaint. I don’t have a review of system (ROS) or full history because the doctor didn’t document a history of present illness (HPI). He did include a brief HPI in the medical assessment that I credited toward the chief complaint. The physician completed an extended, problem-focused exam and medical decision making of low complexity. Can we bill for this encounter? Minnesota Subscriber Answer: According to [...]

Reader Question: Remember V16.8 for Family Melanoma Risk   (January 2012)

Question: Our physicians sometimes see patients who don’t personally have malignant melanoma but have family history that puts them at a high-risk level. What is the ICD-9 code for it?Wisconsin Subscriber Answer: The family history of melanoma falls under the code V16.8 (Family history of malignant neoplasm; other specified malignant neoplasm), which may not be a covered primary diagnosis. Protect yourself: Don’t opt for V16.8 as primary on the claim form. Instead, use the diagnosis(es) [...]

CPT® 2012: Don’t Miss These Clarifications About New Patients and ‘Qualified Healthcare Professional’   (December 2011)

See how changes affect your use of 99201-99205, 99460-99461, and more. Coding guidelines can sometimes seem confusing when you’re trying to decide whether to classify a patient as new or established. For example, when an established patient presents to your practice to see a new physician, should you report a new patient office visit code? CPT® 2012 attempts to clarify this question and one other E/M stumper: Who counts as a “qualified healthcare professional” to [...]

2012 Physician Fee Schedule: Good News: Expect More Flu Vaccine Reimbursement in 2012   (December 2011)

Pay for 3 of your most common vaccine codes will rise. Your family physician should be smiling about the vaccine reimbursement amounts for 2012 ” CMS gave practices a break with updates to its seasonal influenza vaccine pricing. CMS payment changes related to flu vaccines are as follows: 90654 (Influenza virus vaccine, split virus, preservative free, for intradermal use) – $18.383 90655 (Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of [...]

Workers’ Compensation: 2 Tips Point You Toward Pain Free Workers’ Compensation Billing   (December 2011)

Get pertinent information before seeing the patient to avoid trouble when you start the billing process.Just the thought of processing a workers’ compensation claim can bring on a headache, thanks to factors such as workers’ compensation being authorized with federal guidance, but is a state-run program. Add individual state rules, fee schedules, and processes to the mix – and the fact that federal and railroad employees have their own WC programs – and you could be tempted [...]

ICD-10: Ensure Compliance With Sinusitis’ One-to-One Relationship For ICD-10   (December 2011)

Code J32.x with a fourth digit to specify location.When following the ICD-9-CM code set, you report 473.x (Chronic sinusitis) for patients suffering from chronic infection of sinus if the symptoms persist despite two or more months’ treatment. This condition interferes with drainage and causes mucus to build up, and is also known as rhinosinusitis, hyperplastic sinusitis, chronic rhinosinusitis, and chronic unspecified sinusitis.ICD difference: Effective Oct. 1, 2013, you’ll have several location-specific diagnoses to select among. [...]

You Be the Coder: Can Counseling Bump Up Consult Codes?   (December 2011)

Question: Our physician provides pre-op consultations for requesting surgeons. He completed the consult with a recent patient, but also spent quite a bit of time discussing and focusing on the patient’s hypertension. Can we bill that separately as education or counseling (or a problem-focused visit), or is it included in the consult?Illinois SubscriberAnswer: Anything discussed as part of a consult is included in that encounter’s consultation code. That’s one difference between consultations and preventive visits, [...]

Reader Question: J3490 Covers Used EpiPen® Kit in Office   (December 2011)

Question: We used the EpiPen® kit in the office on a patient who experienced an allergic reaction. How do we bill for using the kit? Vermont Subscriber Answer: Use of an EpiPen® represents an injection of epinephrine. As such, it would be appropriate to code its administration using codes 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular) and J0171 (Injection, adrenalin, epinephrine, 0.1 mg).

Reader Question: Only Add Lacerations at Same Site and Level   (December 2011)

Question: A patient with a 1.5-cm laceration on his eyebrow presented to our practice. Our physician performed an intermediate repair. The patient also had a 3.6-cm forehead laceration that required a simple repair. Should we add these two wound lengths together and then code the intermediate repair, or does each get its own code?New York SubscriberAnswer: In this instance, you should report code 12051 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous [...]

Reader Question: Select E Code for Initial Fall Visit   (December 2011)

Question: An established patient came to the office complaining of back pain related to a fall three weeks ago. We aren’t sure of the allowable timeframe for coding falls. Can we still report an E code?New Hampshire Subscriber Answer: The HIPAA mandated ICD-9 coding guidelines state that you should assign the appropriate E code for the initial encounter of an injury but not for subsequent treatment. Although you’re treating an established patient, this is the [...]