CODING & DOCUMENTATION

The ICD-9 coding guidelines instruct you to “List first the ICD-9-CM code for the diagnosis, condition, problem, or other reason for the encounter/visit shown in the medical record to be chiefly responsible for the services provided. List additional codes that describe any coexisting conditions.” Based on this, consider to what extent the new problem and chronic problems were the reason for the services provided. The primary diagnosis is the one that accounted for the greatest portion of your care.

No, it would not be appropriate to report a place of service code that doesn't match the setting where the service was truly provided. Because your CLIA certificate is specific to your office lab, changes in your certification may be required to enable you to do testing elsewhere. Also, Medicare pays skilled nursing facilities under a consolidated billing program that includes the technical costs of lab testing. This may require that either the nursing facility provide the tests or that you contract with the facility to do so. I would suggest consulting a health care attorney before continuing to provide this service.

A pregnancy test performed on the same date as a preventive service may be reported separately using the CPT code appropriate to the test (e.g., 81025, “Urine pregnancy test, by visual color comparison methods”) and a diagnosis code from the V72.4X series (pregnancy examination or test). Note that many payers state that if the initial prenatal care is begun at the same encounter where pregnancy is confirmed, the visit is included in the global OB package and not separately billable.

Code 99211 represents an evaluation and management service where problems are typically minimal and may not require the presence of a physician. The addition of modifier 25 suggests that the service is significant and separately identifiable from the other services. Medicare and many other payers bundle 99211 with 90772.