Fam Pract Manag. 2006;13(3):33-34
Hospital admission following an office visit
When a physician sees a Medicare patient in the office and, in the course of the office visit, determines that hospital admission is required, how should this be coded? Is it necessary to visit the patient again in the hospital after having seen him or her in the office, or is the time spent with the patient in the office sufficient to fulfill the requirements for the admission code?
To submit an inpatient care code, you have to see the patient in the hospital. If you provide the office visit and see the patient in the hospital later that day, you’ll be paid only for the inpatient care code, because Medicare states that “All services provided by the physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission.” If you don’t see the patient in the hospital until the next date, you will be paid for both the evaluation and management visit and the inpatient care, because Medicare also states that “Carriers pay both visits if a patient is seen in the office on one date and admitted to the hospital on the next date, even if fewer than 24 hours has elapsed between the visit and the admission.”
When PAs perform minor surgical procedures
Is our physician assistant (PA) allowed to bill for circumcisions or other minor surgical procedures?
This will depend on what PAs are licensed to do in your state. To find out, contact your state medical society or licensing board. It also depends on your hospital privileges and individual insurance company regulations. The Centers for Medicare & Medicaid Services gives guidelines on billing for services provided by PAs to Medicare patients. These are available in chapter 15, section 190 of the Medicare Benefit Policy Manual at http://www.cms.hhs.gov/manuals/downloads/bp102c15.pdf.
Emergency office services
Can you please explain the proper way to document CPT code 99058, “Service(s) provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service”?
CPT does not clarify the specific documentation for this code. However, in its newsletter, CPT Assistant, the AMA explained that this code is reported for the patient who, in the clinical judgment of the physician, warrants the physician interrupting the care of another patient to deal with the emergency. This could be satisfied by stating, “Patient seen on emergent basis,” and then describing the situation. This code is not used for urgent care time slots (i.e., time periods left open specifically for urgent care appointments) or for patients worked into the schedule who did not require emergent care. Unfortunately, Medicare bundles this code into the other services provided in the office, as do many payers, but you should still submit this code along with the code for the office visit and any other services you provide.
ICD-9 code for tick removal
What is the proper ICD-9 code for removing a tick?
There is no specific ICD-9 code for tick infestation on the skin, although there are such codes for chiggers, lice and leeches. Because a tick is technically a mite, the proper ICD-9 code would be 133.9, “Acariasis, unspecified.”
Immunizations at a preventive visit
How do I code for immunizations to a patient, usually a child, in the context of provided a preventive visit? Does it matter if a nurse administers the vaccine?
The immunization services can be billed on the same claim as the preventive service code. Note that codes 90465–90468 may be used when the physician has counseled the patient or family about the vaccine. Codes 90471–90474 should be used when physician counseling is not provided. This does not require that the physician administer the vaccine. Office staff working incident-to the physician may administer the vaccine. Be sure to code for the vaccine as well.
Performing and interpreting X-rays
CPT says: “When a physician performs both the [X-ray] procedure and provides imaging supervision and interpretation, a combination of procedure codes outside the 70000 series and imaging supervision and interpretation codes are to be used.” Can you clarify this?
This instruction from CPT refers to a physician performing a surgical procedure with imaging and interpretation in the same setting. For instance, when a physician is performing a percutaneous, needle core, breast biopsy using imaging guidance, code 19102 reports the procedure and code 76095 reports the stereotactic localization. If the same physician provides both the procedure and localization (with interpretation), he or she may bill both codes.Note that this instruction does not apply to the provision of X-ray services unrelated to a procedure. For those services, use the appropriate radiology service code and append modifier -TC (technical component only) or modifier -26 (professional component only), if appropriate.
Editor’s note: While this department attempts to provide accurate information and useful advice, third-party payers may not accept the coding and documentation recommended. You should refer to the current CPT and ICD-9 manuals and the Documentation Guidelines for Evaluation and Management Services for the most detailed and up-to-date information.