CODING & DOCUMENTATION

Yes. You should append modifier -25 to the evaluation and management (E/M) code, but you should not need additional modifiers for 69210, “removal impacted cerumen (separate procedure), one or both ears,” or for 93000, “electrocardiogram, routine ECG with at least 12 leads; with interpretation and report,” because these codes do not have work components that overlap with the E/M code. However, some payers might require modifier -59 to indicate that these services were distinct procedural services. Check with your payers to find out their requirements.

Yes. Excision of lesions should be reported by location and size (the width of the lesion plus the margin, i.e., the wound after excision). Report the most significant procedure first. Subsequent lesion excisions should be reported with either modifier -51 to indicate multiple surgeries were performed or modifier -76 if they are reported with the same code as the initial procedure. If multiple distinct lesions are removed using different methods, add an anatomic modifier or modifier -59 to the codes for the subsequent procedures to indicate a different site, a different method or a different lesion. Also, if the repair of the wound involves the layered closure of one or more layers of deep tissues in addition to skin, you can separately report the appropriate intermediate repair codes (12031-12057) or complex repair codes (13100-13160).

You should report CPR with code 92950. Additionally, you can report any significant E/M service provided prior to the patient becoming critical and/or a critical care service provided for less than 30 minutes with an appropriate E/M code. Modifier -25 should be appended to any E/M service code reported on the same date as CPR.If 30 minutes or more of your time was spent doing work directly related to this patient's critical care, report critical care code 99291 for 30 to 74 minutes and 99292 for each additional 30 minutes. Keep in mind that the time you spend performing CPR is not counted in the time used to determine the units of critical care you report. See the introductory text of the Critical Care Services section of CPT for more information.

Subcutaneous and intramuscular injections should be reported with code 90772 in addition to the code that identifies the medication injected. Vitamin B12 should be reported with code J3420, which represents up to 1,000 mcg per unit. Many Medicare carriers have made local coverage decisions regarding vitamin B12 injections that provide reimbursement only for patients with certain types of anemia and other conditions. Check with your carrier and, if indicated, ask the beneficiary to sign an Advance Beneficiary Notice.

Providing oxygen to the patient is not separately reportable as it is incidental to the other services provided to the patient and therefore already included in the practice expense component of the service codes. Bandages, surgical trays and syringes are examples of other incidental items.

Visit the AMA's Web site at http://www.ama-assn.org/ama/pub/category/10902.html. It indicates when the codes become effective and whether a vaccine is still pending FDA approval.

Code 82951, “Glucose; tolerance test (GTT), three specimens (includes glucose),” represents the initial, one-hour and two-hour post-glucose tests. If you perform additional testing beyond these three specimens, report code 82952 for each additional post-glucose test. Note that you do not need a modifier for reporting 82952 in addition to 82951.

Many practice supply companies offer the new CMS-1500 form. If your current supplier does not have the revised form, contact the U.S. Government Printing Office at 866-512-1800 or try other medical practice suppliers, printers or office product stores in your area or online. An Internet search can also help you find companies selling the form.