CODING & DOCUMENTATION

Yes. Append modifier -25 to the evaluation and management (E/M) code to signify that the problem-oriented service was significant and separately identifiable from the work of the preventive service. Many coding professionals recommend that you create two separate notes to help identify which work was associated with each code. This may help to support your claim. Remember that each element of work you perform at the visit can count toward only one of the two services.

If you spend more than half of your face-to-face time counseling the child or the child's caregiver regarding obesity-related health concerns and risk-factor reduction, you may choose a level of service based on time rather than the history, exam and medical decision making components of the service (see “Time Is of the Essence: Coding on the Basis of Time for Physician Services,” FPM, June 2003). Be aware that not all insurers cover services related to obesity.

If there was a global period assigned to the initial service you provided, you cannot separately report each dressing change. Reimbursement for any dressing changes provided within that time frame is included in the global fee.If a global period does not apply, you may report dressing changes using an E/M code. If the dressing change is performed by nursing staff under incident-to conditions, you may use code 99211. When performed by a physician, dressing changes for burns and debridement of burn tissue should be reported using codes 16020–16030, depending on the size of the burn.

No. Code 90772 does not accurately describe the procedure. You should report only code 86580, which includes the intradermal injection. If on a later date you examine the injection site for a reaction, then you may report an E/M code for the services rendered on that date. If a nursing staff member performs the exam of the injection site, it may be reported with code 99211. Incident-to rules may apply for 99211 services, so check with your payer.