CODING & DOCUMENTATION

ICD-9 code V74.1 represents a special screening examination for pulmonary tuberculosis, including diagnostic skin testing for the disease. Often code V70.5, “Health examination of defined subpopulations,” may be a secondary diagnosis to indicate the test is performed as part of a pre-employment or occupational health examination. Additional ICD-9 codes may be reported to indicate the patient's risk for tuberculosis. For example, report V01.1 for “Contact with or exposure to tuberculosis,” 042 for HIV infection or 793.1 for “Nonspecific abnormal findings of radiological and other examination of the lung field.”Remember that when a patient returns for the PPD reading, even when the reading is done by a nurse working incident to your services, you may report code 99211 for this evaluation and management (E/M) service.

The most current Medicare utilization data for family medicine indicates that 58 percent of established patient office visits were coded 99213 and 28 percent were coded 99214. Forty-three percent of new patient visits were coded 99203 and 27 percent were coded 99204. This data is available from the Centers for Medicare & Medicaid Web site at http://www.cms.hhs.gov/MedicareFeeforSvcPartsAB/04_MedicareUtilization-forPartB.asp.Other data sources include cost surveys such as those sold by the Medical Group Management Association (http://www.mgma.com). The Medicare contractor for your area may also provide regional utilization data.It is important to periodically review the accuracy of your coding and documentation practices through internal or external chart review and compare the results to benchmarks such as these. For more information on how to track and analyze your coding patterns, see “How to Analyze Your E/M Coding Profile,” FPM, April 2007.

You need to consult the adjustment reason codes on the remittance advice. If the reason for the denial is unclear, contact the payer for clarification. It is possible you are receiving denials because you are not completing the accident information in sections 10 and 14 of the claim form or not reporting E codes. This information indicates what happened to the patient, where it happened and under what circumstances. Payers need this information to determine liability for claims. For instance, an E code can identify how the patient with the contusion got it (e.g., E888.1 would indicate that the patient fell and hit the bath tub, or E849.0 would indicate that the contusion occurred at home). The more information you provide to the payer, the less likely that your claim's processing will be delayed while the payer seeks information from the patient.

It depends on the payer. For a patient under the care of Medicare-covered home health, report code G0181 when 30 minutes or more of your time is spent in care plan oversight activities during a calendar month. Other payers may pay for code 99374 for a patient who is under the care of a home health agency; it indicates that the physician spent 15 to 29 minutes in a calendar month on any of the following activities: Development or revision of care plans;Review of subsequent reports of patient status;Review of related laboratory and other studies;Communication (including telephone calls) for purposes of assessment or care decisions with health professionals, family members, surrogate decision makers (e.g., legal guardians) or key caregivers involved in the patient's care;Integration of new information into the treatment plan or adjustment of medical therapy.Your home visits are separately billable using a home services code (99341-99350). Also consider that where care plan oversight does not apply, home health certification or recertification might. See “An Update on Certifying Home Health Care,” FPM, May 2001, for more information on reporting these services.

It may be advisable to provide these services on a cash-only basis. Payers will typically not reimburse for procedures unless they are medically necessary.The codes for Botox injections (both cosmetic and medically necessary) are as follows: 46505, Chemodenervation of internal anal sphincter;64612-64614, Chemodenervation of muscle(s) innervated by facial nerve, neck muscles, or extremities or trunk muscles;64650-64653, Chemodenervation of eccrine glands or other areas.Report Botulinum toxins with code J0585, “Botulinum toxin, type A, per unit,” or J0587, “Botulinum toxin, type B, per 100 units.” For filler injections, see codes 11950-11954, “Subcutaneous injection of filling material,” or HCPCS code S0196, “Injectable poly-l-lactic acid, restorative implant, 1 mL, face (deep dermis, subcutaneous layers).” For sclerotherapy, see codes 36468-36471, “Single or multiple injections of sclerosing solutions, spider veins (telangiectasia).”When reporting services provided for cosmetic reasons, consider ICD-9 codes in the V50 series, “Elective surgery for purposes other than remedying health states.”

Medicare often establishes G codes to differentiate its requirements from the requirements listed in CPT for similar services. Other payers may reimburse certain G codes (e.g., care plan oversight code G0181). Medicaid plans are administered on the state level, and each state may have different guidelines for coverage and coding of services. Check with your state Medicaid administrator for guidance on reporting care plan oversight services.

You should use code 94664, “Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler, or IPPB device,” to report instruction to patients on the use of these devices. You or qualified medical staff (e.g., a medical assistant or nurse) working incident to your service may use this code.Because some payers bundle code 94664 with E/M services provided on the same date, you should append modifier 25 to the E/M code to increase the chances that you will be paid for both services.