CODING & DOCUMENTATION

CPT code 99375 does accurately describe the care you provided, but Medicare does not recognize this code. Instead, you should submit G0181, “Physician supervision of a patient receiving Medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) with other health care professionals involved in the patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more,” when you provide this service to Medicare patients (or G0182 if the patient is under a Medicare-approved hospice).

Yes. Code V58.53 describes an encounter for therapeutic drug monitoring, where “drug monitoring” refers to the measurement of the level of a specific drug in the body or the measurement of a specific function to assess the effectiveness of a drug. If the prescription drugs you are managing represent long-term (current) drug use (e.g., for Coumadin treatment) you should use an additional code in the series V58.61–V58.69. However, if none of these V codes is appropriate, you can just report the ICD-9 code for the underlying condition that requires the prescription drug.

Yes. The work RVUs assigned to the ob ultrasound codes (76801–76817) represent only the professional component of the service (the physician interpretation and report). The technical component (the actual performance of the ultrasound) is captured principally through the practice-expense RVUs. If a physician, rather than a technician, is doing the ultrasound, you may want to credit the physician with the practice-expense RVUs in addition to the work RVUs. In the case of 76801, this would be 3.44 RVUs (0.99 work RVUs and 2.45 practice-expense RVUs), which would be comparable to the 3.69 work RVUs for a diagnostic colonoscopy (code 45378).

It depends on the payer. Because CPT does not specify what the term “removal” refers to with this code, removal by any means would qualify from a CPT perspective. Assuming Medicare's “incident-to” rules are met, you should also be able to code this as incident-to a physician's service in some cases. (For more information on “incident-to” reimbursement, see “The Ins and Outs of “Incident-To” Reimbursement,” FPM, November/December 2001, page 23.)However, according to CMS, payment for cerumen removal is made only when the following criteria are met:1. The service is the sole reason for the patient encounter;2. The service is personally performed by a physician or non-physician (NP, PA, CNS);3. The service is provided to a patient who is symptomatic;4. The documentation illustrates significant time and effort spent performing the service.CMS also defines routine cerumen removal as the use of softening drops, cotton swaps and/or cerumen spoon and is not paid separately since it is considered incidental to the office visit.These criteria may also be true for some commercial payers. Check with your individual payers to determine their policies.

The newborn-care codes are generally used for healthy newborns, which is why the descriptors reference a “normal” newborn (e.g., 99431, “History and examination of the normal newborn infant, initiation of diagnostic and treatment programs and preparation of hospital records. (This code should also be used for birthing room deliveries)”). Initial and subsequent hospital care codes should be used instead of the newborn-care codes when the newborn is ill (but not critically ill). If the newborn is critically ill, you should consider using the inpatient neonatal critical care codes 99295 and 99296.

According to CPT, you should submit codes 99371–99373 for the types of telephone calls you've described. Some, but not all, payers will reimburse you for these codes, and among those who don't, some may allow you to collect from the patient for the “noncovered” service. However, Medicare and many other payers consider telephone calls to be “bundled” services, which means they will not separately reimburse you for them or allow you to collect from the patient for them (since the payer considers payment for these codes to be included in the payment made for other services you provide, such as office visits). You will need to check each of your health plan contracts to see which plans fall into which category.

It depends on the exact nature of the facility. If the facility qualifies as a nursing facility (such as an intermediate care facility for the intellectually disabled), you should use the subsequent nursing-facility codes (99311–99313). Alternatively, if the facility is more akin to an assisted-living or custodial-care facility or a group home, you should use the domiciliary-care codes (99321–99333). Note that these codes have documentation requirements that must be met to support the billing level.

For Depo-Testosterone, you should submit either J1070, “Injection, testosterone cypionate, up to 100 mg,” or J1080, “Injection, testosterone cypionate, 1 cc, 200 mg.”Code J1060, “Injection, testosterone cypionate and estradiol cypionate, up to 1 ml,” is used for such things as Depo-Testadiol or Andro/Fem.

Lipomas are typically benign tumors commonly found in superficial tissue. Accordingly, one of the codes for excision of a benign skin lesion of the scalp (11420–11426) would be most appropriate in your case. If a layered closure is required, you should also report the appropriate intermediate repair code (12031–12037).